Increased risk of vertebral fracture in patients with rheumatoid arthritis

Abstract

The relationship between rheumatoid arthritis and risk of vertebral fracture has been reported by several observational studies. However, there is no higher-level evidence study, such as meta-analysis, that has investigated the relationship, and its mechanisms are not yet fully clear. This meta-analysis aimed to provide a summary of an observational study of the relationship between rheumatoid arthritis and the risk of vertebral fractures.Relevant studies were identified by searching PubMed and EMBASE databases (up to August 1, 2016). We included published observational studies (cohort or case-control design) evaluating the relationship between rheumatoid arthritis and the risk of vertebral fractures. Two reviewers searched and abstracted the data independently. Relative risks (RRs) with 95% confidence intervals (CIs) were used throughout the whole analysis.Seven observational studies (2 cohort studies, 2 nested case-control studies, and 3 case-control studies) were included in this meta-analysis. The results showed that the pooled RR of vertebral fracture for individuals with rheumatoid arthritis was 2.34 (95% CI 2.05–2.63, I2 = 35.4%, P for heterogeneity = 0.16). Further subgroup analysis by sex showed that the pooled RRs for both women and men, and only women were 2.14 (95% CI 1.47–2.8, I2 = 48.5%, P for heterogeneity = 0.12) and 2.39 (95% CI 2.07–2.70, I2 = 34%, P for heterogeneity = 0.22), respectively. Subgroup analysis by study design showed that the pooled RRs for cohort studies, nested case-control studies, and case-control studies were 2.31 (95% CI 1.95–2.67, I2 = 4.8%, P for heterogeneity = 0.31), 1.89 (95% CI 1.01–2.77, I2 = 72.1%, P for heterogeneity = 0.06), and 2.62 (95% CI 2.04–3.91, I2 = 26.1%, P for heterogeneity = 0.26), respectively.Based on our meta-analysis, rheumatoid arthritis should be regarded as an independent risk factor of vertebral fracture. Further studies are needed to institute prevention and treatment strategies.

Osteoporosis in Rheumatic Diseases

“…In addition, two meta-analyses showed a 60 to 100% higher risk of fracture in RA patients compared to healthy controls [39,40]. Another meta-analysis, focused only on vertebral fractures, confirmed a similar two-fold increase in vertebral fracture risk in RA patients [41]. However, despite these alarming data, only about 45% of RA patients are receiving calcium and vitamin D supplements [42], and only 5.4% of RA patients who are not taking glucocorticoids (GCs) are using bisphosphonates [43].…”

Medications associated with fracture risk in patients with rheumatoid arthritis

“…Rheumatoid arthritis (RA) is associated with twofold increased risk of osteoporosis (OP) and fractures across all age groups compared with the general population 1 2. Osteoporotic fractures can lead to reduced quality of life, disability and increased mortality in patients with RA 3.…”

Do rheumatoid arthritis patients have more major complications and length of stay after lower extremities fracture surgery?

“…[7,8] Furthermore, RA patients have higher rate of fracture in vertebral, hip, or other part of the body when comparing to osteoporotic patients. [7,9,10] Lower limb fracture surgeries account for approximately 40% of all fracture surgeries, among which hip fractures (ie, femoral neck fractures), foot fracture (ie, tarsal/metatarsal/phalangeal fractures), and ankle fractures rank top 3. [11] In general, postoperative complications are more likely to occur in patients who undergo lower limb surgeries, especially those who receive hip fracture surgeries; [12] the incidence of the various complications in patients who receive hip fracture surgeries is approximately 19%, including cardiac and pulmonary complications, myocardial infarctions, strokes, and renal failure.…”