Osteoporosis and fragility fractures in rheumatoid arthritis

2013 ◽  
Author(s):  
Glenn Haugeberg
Keyword(s):  
Rheumatoid Arthritis ◽  
Fragility Fractures

scholarly journals Bone Loss, Osteoporosis, and Fractures in Patients with Rheumatoid Arthritis: A Review

2020 ◽  
Vol 9 (10) ◽  
pp. 3361
Author(s):  
Patrice Fardellone ◽  
Emad Salawati ◽  
Laure Le Monnier ◽  
Vincent Goëb
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Bone Loss ◽  
Interleukin 1 ◽  
Bone Destruction ◽  
Fragility Fractures ◽  
Systemic Effect ◽  
Vertebral Fracture Assessment ◽  
Mineral Density ◽  
Accurate Treatment

Rheumatoid arthritis (RA) is often characterized by bone loss and fragility fractures and is a frequent comorbidity. Compared with a matched population, RA patients with fractures have more common risk factors of osteoporosis and fragility fractures but also risk factors resulting from the disease itself such as duration, intensity of the inflammation and disability, and cachexia. The inflammatory reaction in the synovium results in the production of numerous cytokines (interleukin-1, interleukin-6, tumor necrosis factor) that activate osteoclasts and mediate cartilage and bone destruction of the joints, but also have a systemic effect leading to generalized bone loss. Regular bone mineral density (BMD) measurement, fracture risk assessment using tools such as the FRAX algorithm, and vertebral fracture assessment (VFA) should be performed for early detection of osteoporosis and accurate treatment in RA patients.

Fragility Fractures in Patients with Rheumatoid Arthritis and Osteoarthritis Compared with the General Population

2015 ◽  
Vol 42 (11) ◽  
pp. 2055-2058 ◽  
Author(s):  
Yuri Yamamoto ◽  
Aleksandra Turkiewicz ◽  
Hans Wingstrand ◽  
Martin Englund
Keyword(s):  
Rheumatoid Arthritis ◽  
Hip Fracture ◽  
Rate Ratio ◽  
Trochanteric Fracture ◽  
Hip Osteoarthritis ◽  
Fragility Fractures ◽  
Fracture Rate ◽  
Healthcare Data ◽  
Knee Oa ◽  
Rate Ratios

Objective.To determine the rate ratios of hip and distal radius fractures in patients with rheumatoid arthritis (RA), hip osteoarthritis (OA), and knee OA.Methods.Cohort study using healthcare data (1998–2012) covering the entire population of the Skåne region of Sweden.Results.We found an increased rate of hip fracture in both female [standardized fracture rate ratio (SFR) 1.54, 95% CI 1.40–1.70] and male patients with RA (SFR 1.81, 95% CI 1.51–2.17). The hip fracture rate in female OA was reduced by 10–20%, and trochanteric fracture tended to have a higher rate ratio compared with the cervical.Conclusion.The 50–80% increased rate of hip fracture adds to the total burden of RA while the shifted distribution of cervical/trochanteric fractures in OA is in support of subchondral bone alterations.

Rheumatoid Arthritis is a Risk Factor for Refracture in Patients with Fragility Fractures

2021 ◽  
Author(s):  
Hotaka Ishizu ◽  
Hirokazu Shimizu ◽  
Tomohiro Shimizu ◽  
Taku Ebata ◽  
Yuki Ogawa ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factor ◽  
Propensity Score ◽  
Primary Outcome ◽  
Fragility Fractures ◽  
Increased Risk ◽  
Substantial Risk ◽  
Multivariable Analyses

Abstract Objectives To determine whether patients with rheumatoid arthritis (RA) who have had fragility fractures are at an increased risk of refractures. Methods Patients with fragility fractures who were treated surgically at ten hospitals from 2008 to 2017 and who underwent follow-up for more than 24 months were either categorized into a group comprising patients with RA or a group comprising patients without RA (controls). The groups were matched 1:1 by propensity score matching. Accordingly, 240 matched participants were included in this study. The primary outcome was the refracture rate in patients with RA as compared to in the controls. Multivariable analyses were also conducted on patients with RA to evaluate the odds ratios (ORs) for the refracture rates. Results Patients with RA were significantly associated with increased rates of refractures during the first 24 months (OR: 2.714, 95% confidence interval [95% CI]: 1.015–7.255; P = 0.040). Multivariable analyses revealed a significant association between increased refracture rates and long-term RA (OR: 6.308, 95% CI: 1.195–33.292; P=0.030). Conclusions Patients with RA who have experienced fragility fractures are at an increased risk of refractures. Long-term RA is a substantial risk factor for refractures.

Incident Comorbidity Among Patients with Rheumatoid Arthritis Treated or Not with Low-dose Glucocorticoids: A Retrospective Study

2010 ◽  
Vol 37 (11) ◽  
pp. 2232-2236 ◽  
Author(s):  
MAURIZIO MAZZANTINI ◽  
ROSARIA TALARICO ◽  
MARICA DOVERI ◽  
ARIANNA CONSENSI ◽  
MASSIMILIANO CAZZATO ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Myocardial Infarction ◽  
Retrospective Study ◽  
Arterial Hypertension ◽  
Low Dose ◽  
Fragility Fractures ◽  
The Other ◽  
Prevention Measures ◽  
Accurate Identification ◽  
High Prevalence

Objective.To assess the prevalence of comorbidity in a cohort of patients with rheumatoid arthritis (RA), treated or not with low-dose glucocorticoids (GC) and who have been followed for at least 10 years.Methods.This was a retrospective study by review of medical records.Results.We identified 365 patients: 297 (81.3%) were GC users (4–6 mg methylprednisolone daily) and 68 (18.7%) were nonusers. We found that fragility fractures occurred in 18.2% of GC users and in 6.0% of GC nonusers (p < 0.02); arterial hypertension in 32.3% of GC users and in 10.4% of GC nonusers (p < 0.0005); acute myocardial infarction in 13.1% of GC users and in 1.5% of the nonusers (p < 0.01). Prevalence of diabetes mellitus, cataract, and infections was comparable. We divided GC users into groups of different duration of GC therapy: < 2, 2–5, and > 5 years; the mean duration of GC treatment was 1.3 ± 0.5, 3.6 ± 1.1, and 12.1 ± 5.1 years, respectively. GC treatment for > 5 years was associated with significantly higher prevalence of fragility fractures (26.6%; p < 0.001 vs the other groups), arterial hypertension (36.7%; p < 0.0002 vs nonusers and GC users < 2 years), myocardial infarction (16.1%; p < 0.01 vs nonusers), and infections (9.7%; p < 0.005 vs the other groups). GC treatment for 2–5 years was associated with a significantly higher prevalence of arterial hypertension (30.0%; p < 0.01) compared to nonusers.Conclusion.Patients with RA treated with low-dose GC compared to patients never treated with GC show a higher prevalence of fractures, arterial hypertension, myocardial infarction, and serious infections, especially after 5 years of GC treatment. The high prevalence of myocardial infarction and fractures in patients with RA suggests that a more accurate identification of risk factors and prevention measures should be adopted when longterm GC treatment is needed.

scholarly journals Bone mineral density and microarchitecture among Chinese patients with rheumatoid arthritis: a cross-sectional study with HRpQCT

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Shangyi Jin ◽  
Mengtao Li ◽  
Qian Wang ◽  
Xiaofeng Zeng ◽  
Weibo Xia ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Bone Mineral Density ◽  
Bone Mineral ◽  
Bone Microarchitecture ◽  
Fragility Fractures ◽  
Cross Sectional Study ◽  
Mineral Density ◽  
Cross Sectional ◽  
X Ray ◽  
Increased Risk

Abstract Background Patients with rheumatoid arthritis (RA) are at increased risk of fractures. Although their decline in bone mineral density (BMD) is well-established, data regarding the alterations in bone microarchitecture are limited. In this study, we aimed to evaluate bone microarchitecture, geometry, and volumetric BMD among patients with RA in mainland China using high-resolution peripheral quantitative computed tomography (HRpQCT). Methods In this cross-sectional study, patients with RA were recruited from the Peking Union Medical College Hospital site of the Chinese Registry of rhEumatoiD arthrITis (CREDIT). Each participant underwent HRpQCT scanning (Scanco XtremeCT II), thoracolumbar X-ray and dual-energy X-ray absorptiometry. The primary outcomes were HRpQCT-related measures at distal radius and tibia. Data regarding demographic features, RA-related characteristics, and history of fragility fractures were collected. Correlation between HRpQCT parameters and potentially related factors were analyzed using linear regression analysis. A group of age- and sex-matched healthy controls was included for comparison. Results A total of 81 patients with RA [69 women, aged 57.9 ± 8.7 years, disease duration 5.7 (IQR 1.4–11.2) years] and 81 matched healthy controls were included. Compared with controls, patients with RA had significantly larger bone area and lower total and trabecular vBMD at both the distal radius and tibia. Lower cortical bone thickness was also shown at the distal tibia. Among patients with RA, advanced age, low BMI, female sex, disease duration, and activity were associated with decreased vBMD and impaired bone microstructure. Female reproductive factors including menopause, late menarche, breast feeding, and early childbirth also showed negative correlation with these parameters. Compared to patients with RA without fractures, patients with fragility fractures (n = 11) showed lower trabecular and cortical vBMD, thinner cortical bone, impaired trabecular microstructure, and a trend of declined bone strength. Current glucocorticoid intake was related to decreased vBMD, trabecular number, increased trabecular separation, and inhomogeneity. Conclusions In this study, we observed alterations in bone mineral density, geometry, and microarchitecture among patients with RA compared to healthy individuals, which may impair bone strength and lead to increased risk of fractures. Both traditional risk factors for osteoporosis and RA-associated factors need to be considered in the assessment of the bone quality.

scholarly journals Fragility Fractures Are Associated with an Increased Risk for Cardiovascular Events in Women and Men with Rheumatoid Arthritis: A Population-based Study

2017 ◽  
Vol 44 (5) ◽  
pp. 558-564 ◽  
Author(s):  
Orla Ni Mhuircheartaigh ◽  
Cynthia S. Crowson ◽  
Sherine E. Gabriel ◽  
Veronique L. Roger ◽  
L. Joseph Melton ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Fragility Fracture ◽  
Fragility Fractures ◽  
Population Based ◽  
Cvd Risk ◽  
Cox Models ◽  
Excess Morbidity ◽  
Increased Risk ◽  
Time Dependent Covariates

Objective.Women and men with rheumatoid arthritis (RA) have an increased risk for fragility fractures and cardiovascular disease (CVD), each of which has been reported to contribute to excess morbidity and mortality in these patients. Fragility fractures share similar risk factors for CVD but may occur at relatively younger ages in patients with RA. We aimed to determine whether a fragility fracture predicts the development of CVD in women and men with RA.Methods.We studied a population-based cohort with incident RA from 1955 to 2007 and compared it with age- and sex-matched non-RA subjects. We identified fragility fractures and CVD events following the RA incidence/index date, along with relevant risk factors. We used Cox models to examine the association between fractures and the development of CVD, in which fractures and CVD risk factors were modeled as time-dependent covariates.Results.There were 1171 subjects (822 women; 349 men) in each of the RA and non-RA cohorts. Over followup, there were 406 and 346 fragility fractures and 286 and 225 CVD events, respectively. The overall CVD risk was increased significantly for RA subjects following a fragility fracture (HR 1.81, 95% CI 1.38–2.37) but not for non-RA subjects (HR 1.18, 95% CI 0.85–1.63). Results were similar for women and men with RA.Conclusion.Fragility fractures in both women and men with RA are associated with an increased risk for CVD events and should raise an alert to clinicians to target these individuals for further screening and preventive strategies for CVD.

scholarly journals Risk factors associated with bone loss and occurrence of fragility fractures in rheumatoid arthritis patients

2019 ◽  
Vol 41 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Hamdi Wafa ◽  
Alaya Raja ◽  
Kaffel Dhia ◽  
Boughanmi Nada ◽  
Zouche Imene ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Bone Loss ◽  
Fragility Fractures ◽  
Factors Associated

scholarly journals Effect of Irregular Treatment on Severity of Osteoporosis in Rheumatoid Arthritis Patients

2021 ◽  
Vol 21 (2) ◽  
pp. 83-88
Author(s):  
Saif Abdulkareem Raoof Al-Shaibani ◽  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Disease Duration ◽  
Fragility Fractures ◽  
Cross Sectional Study ◽  
Inflammatory Disorder ◽  
Severe Osteoporosis ◽  
Cross Sectional ◽  
Systemic Complications ◽  
Delay In Diagnosis

Background:Rheumatoid arthritis is a chronic systemic inflammatory disorder that is associated with progressive disability and systemic complications. One of these complications is osteoporosis. Patients with severe osteoporosis have one or more fragility fractures in addition to T-score -2.5 or lower. Osteoporosis is more prevalent in rheumatoid arthritis patients who have higher disease activity. Objective: To show the effect of irregular treatment in patients with rheumatoid arthritis on the severity of osteoporosis. Patients and Methods: A cross-sectional study enrolled a total of 40 female patients who had rheumatoid arthritis. The data collected from patients include disease duration, disease activity and patients’ compliance to their drugs. They were sent to dual-energy x- ray absorptiometry scan and results were recorded. Results: The mean age was 45.95 ± 10.0 years; 45% of them had rheumatoid arthritis for less than five years; 55% had a low level of disease activity; and 65% of them had received treatment irregularly. Osteoporosis was diagnosed in 60% of them and 41.7% of them had severe osteoporosis. The highest prevalence of osteoporosis among patients with rheumatoid arthritis was seen significantly among older patients, patients with longer duration of rheumatoid arthritis, those with higher activity of rheumatoid arthritis, and those with irregular treatment. More than half of those who received treatment irregularly had severe osteoporosis with a significant association between treatment regularity of rheumatoid arthritis and severity of osteoporosis. Conclusion: Severe osteoporosis occurs in rheumatoid arthritis patients with a history of irregular treatment which occurs either due to patient incompliance or delay in diagnosis. Osteoporosis is more prevalent in rheumatoid arthritis patients with longer disease duration, older age, higher disease activity and those who received treatment irregularly. Keywords: Rheumatoid arthritis, Osteoporosis, Irregular Treatment

scholarly journals Vitamin D, Inflammation and Osteoporosis in Rheumatoid Arthritis

2018 ◽  
Vol 12 (1) ◽  
pp. 300-312 ◽  
Author(s):  
Pier Paolo Sainaghi ◽  
Antonello Gibbin
Keyword(s):  
Rheumatoid Arthritis ◽  
Vitamin D ◽  
Parathyroid Hormone ◽  
Bone Loss ◽  
Adaptive Immunity ◽  
Bone Health ◽  
Fragility Fractures ◽  
Molecular Pathways ◽  
Innate And Adaptive Immunity ◽  
Physiological Processes

Patients with Rheumatoid Arthritis (RA) commonly develop osteoporosis and fragility fractures. This fact cannot be explained only with the use of glucocorticoids, known to be detrimental for bone health. RA is characterized by a chronic inflammation caused by the continuous activation of innate and adaptive immunity with proinflammatory cytokines overproduction. This process is detrimental for several organs and physiological processes, including the impairment of bone remodeling. We will briefly review the pathogenesis of inflammation-related bone loss in RA, describing well-known and new molecular pathways and focusing on vitamin D and Parathyroid Hormone role.

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