Fall-related risk factors and osteoporosis in women with rheumatoid arthritis

Kaz, H Kaz; Johnson, David W.; Kerry, Sally; Chinappen, U.; Tweed, Karen; Patel, Sanjeev

doi:10.1093/rheumatology/keh304

Cited by 84 publications

(30 citation statements)

References 25 publications

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“…Other studies have indicated functional disability as a risk factor for falls, but in our study, although it was associated with poorer performance in physical tests, it was not correlated with falls [4,9,12,13,19,20,35]. In a prospective study with 80 patients in Japan, Hayashibara et al [6] found no relationship between functional disability and the presence of falls and explained that the : chi-square; P: significance level findings were due to the fact that five of the eight HAQ categories assess the function of the upper limbs.…”

Section: Discussioncontrasting

confidence: 66%

“…The incidence of falls in this sample of RA patients was high (48.8%) compared to that found in the literature, which shows ranges from 14.3 to 54% in retrospective studies and from 18.8 to 50% in prospective studies [4][5][6][7][8][9][11][12][13][14][15][16][17][18][19]. The incidence of falls observed was also high compared to that of noninstitutionalized elderly individuals, which ranges from 15.9 to 56.3% [2].…”

Section: Discussionmentioning

confidence: 60%

“…Rheumatoid arthritis (RA) is a chronic systemic inflammatory autoimmune disease of joint predominance, with a high prevalence of falls occurring in 14.3 to 54% of patients over a one-year period, which are high values compared to the general population [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. This increased risk of falls may be due to pain, edema, deformities, loss of muscle strength or gait changes, and prospective studies have shown associations with altered balance, use of psychotropic medications, fear of falling and previous falls [4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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Characterization of falls in adults with established rheumatoid arthritis and associated factors

2018

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Background: Rheumatoid arthritis patients may have an increased risk of falls due to changes caused by the disease such as muscle weakness, joint impairment, reduced mobility and postural instability. The aim of this study was to prospectively analyze the occurrence of falls in RA patients and its risk factors. Methods: A cohort of 86 RA patients were assessed over 1 year for disease activity using the Disease Activity Score (DAS-28), for functionality using the Health Assessment Questionnaire (HAQ), for the characterization of falls and for the use of medications, and they were subjected to the Berg Balance Scale (Berg), Timed Up and Go (TUG), 6-Minute Walk (6MWT) and Short Physical Performance Battery (SPPB) tests. The Kolmogorov-Smirnov, Spearman's correlation, Student's t, Mann-Whitney and chi-square tests were performed with a significance level of P ≤ 0.05. Results: A total of 86 patients were evaluated, of which 48.8% had at least one fall and 75.6% reported having a fear of falling. No association of falls with age, disease duration, functional capacity, disease activity or physical performance was found. Patients with poorer performance in the physical tests had more functional impairment, higher disease activity and more advanced age. No differences in physical or functional performance, disease activity, gender or fear of falling were found between fallers and non-fallers; only a greater amount of medications used was found in the group of fallers. Conclusions: The occurrence of falls was high and associated with a previous history of falls and polypharmacy, with no association with disease activity or duration, functional capacity, physical performance, age or gender.

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Section: Discussioncontrasting

confidence: 66%

Section: Discussionmentioning

confidence: 60%

Section: Introductionmentioning

confidence: 99%

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Characterization of falls in adults with established rheumatoid arthritis and associated factors

2018

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“…Die Prüfung von Koordination, Kraft und Balance bei einem komplexen Krankheitsbild wie der RA wurde zur Ermittlung des Sturzrisikos bisher wenig beschrieben [6,7]. In der hier vorgestellten Studie werden 3 verschiedene Test (CR-Test, TUG-Test und TS) gleichzeitig angewandt.…”

Section: Diskussionunclassified

Wertigkeit von Sturzrisikotests bei Patienten mit rheumatoider Arthritis

et al. 2011

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The aim of the study was to quickly and efficiently determine the risk of falling in patients with rheumatoid arthritis over the age of 46 with established methods, to discover parameters which influence the risk of falling and fractures. The study group consisted of 67 patients (median age 69±7.4 years, duration of disease <10 years 71%).With the help of the present data on fractures the performance of the chair-rising (CR) test, the timed up-and-go (TUG) test and the tandem stand (TS) test plus determination of the average daily and cumulative glucocorticoid (GC) dosage, it was possible to detect parameters which influence the risk of falling and fractures.Higher age (>60 years), overweight, deficits in muscle strength in the lower extremities and very low GC dosage (≤5 mg) were found to be associated with an increased risk of falling, which is accompanied by an increased risk of fractures.

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“…Одним из осложнений РА яв-ляется вторичный остеопороз (ОП), на фоне которого у больных чаще, чем в популяции, возникают переломы позвонков, бедра и других костей [2][3][4]. Ведущими причинами возникновения ОП и переломов при РА яв-ляются хроническое воспаление, сопровождающееся активацией клеточного звена иммунитета и повышени-ем продукции провоспалительных цитокинов, прием глюкокортикоидов (ГК), снижение функциональной активности и высокий риск падений [5,6]. Имеются неоспоримые доказательства взаимосвязи снижения минеральной плотности кости (МПК) с активностью заболевания (DAS, СОЭ и уровнем С-реактивного бел-ка) [7][8][9][10], состоянием функционального статуса (HAQ) [3,4,7] и длительностью болезни [2,7].…”

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The Risk of Osteoporotic Fractures in Patients With Rheumatoid Arthritis: Results of the Program «osteoscreening Russia»

Никитинская¹,

Торопцова²,

Демин³

et al. 2018

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Rheumatoid arthritis (RA) and the use of glucocorticoids (GCs) are proven risk factors for osteoporosis (OP) and osteoporotic fractures (OPF). There are also other reasons for increased fracture risk in RA.Objective: to determine the rate of RA in an epidemiological sample of persons aged 50 years and older and to identify those in need of antiosteoporotic therapy among the patients with RA in order to prevent OPF.Subjects and methods. The epidemiological sample included 18,018 people aged 50 years and older (13,941 women and 4,077 men; mean age, 62±10 years). The survey consisted of a unified questionnaire, measurement of daily dietary calcium intake, and calculation of a 10-year fracture risk using the FRAX® algorithm.Results and discussion. The prevalence of RA in the epidemiological population sample aged 50 years and older was 1.7% (1.9% in women and 1.2% in men; p=0.0047). The mean FRAX® values for major OPF in RA patients were significantly higher than those in non-RA individuals: 18.4±10 and 13.2±7.9%, respectively (p=0.0001) for women and 8.9±6.4 and 6.2±3.7%, respectively (p=0.0001) for men. 42% of the patients with RA were at high risk for OPF. Thus, 48% of the women with RA had FRAX® values above the therapeutic intervention threshold; and the non-RA group needed antiosteoporotic therapy significantly less (31%; p=0.00001). At the same time, the detection rate of high-risk OPF in men with and without RA did not differ significantly (8 and 5%, respectively; p>0.05). The most common risk factors (RFs) for OP and OPF in RA patients included previous fractures (33%), secondary causes of OP (30%), GC use (18%), and, additionally, smoking (33%) in male patients with RA. The female patients with RA significantly more frequently took GCs (17%) and had other secondary causes of OP and OPF (33%) than those without RA (7.7% (p=0.0001) and 23% (p=0.0004, respectively). The male patients with RA versus to the population-based control showed significant differences when they only used GCs (20 and 5%, respectively; p = 0.0001); the remaining RFs were encountered at the same frequency. Less than half of the normal daily calcium intake was observed in 20% of men and 16% of women (p=0.53).Conclusion. 42% of the RA patients aged 50 years and older were at high risk for OPF and needed antiosteoporotic therapy. Every third woman with RA had at least one other comorbidity or condition associated with the increased risk of OPF. In the male patients with RA, the FRAX® algorithm could reveal only 8% of persons at high risk for fractures, while 58% of them had two or more additional RFs that can negatively affect bone mineral density and increase the risk of fracture. To identify those who require prevention and treatment of OP and OPF, it is preferable to perform bone densitometry of the axial skeleton among male patients with RA.

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Fall-related risk factors and osteoporosis in women with rheumatoid arthritis

Abstract: Fall-related risk factors predictive of hip fracture are common in women with RA. Fall risk needs to be considered when RA patients are being treated for osteoporosis and further work needs to be done to help reduce the risk of falling and fracture in women with RA.

Cited by 84 publications

References 25 publications

Characterization of falls in adults with established rheumatoid arthritis and associated factors

Characterization of falls in adults with established rheumatoid arthritis and associated factors

Wertigkeit von Sturzrisikotests bei Patienten mit rheumatoider Arthritis

The Risk of Osteoporotic Fractures in Patients With Rheumatoid Arthritis: Results of the Program «osteoscreening Russia»

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