Rheumatoid arthritis patients with hip fracture: a nationwide study

Lin, Yu‐Chih; Li, Y.-H.; Chang, Chih‐Hsiang; Hu, Chih-Chien; Chen, D. W.; Hsieh, Pang‐Hsin; Lee, M. S.; Ueng, Steve Wen–Neng; Chang, Yu‐Han

doi:10.1007/s00198-014-2968-y

Cited by 41 publications

(27 citation statements)

References 30 publications

(35 reference statements)

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“…A population-based cohort study by Gabriel et al reported that comorbidities increased risk of death in RA patients, with hazard ratios (HR) of 1.6 (95% CI 1.2–2.1) for cardiovascular disease and 1.9 (95% CI 1.4–2.6) for malignancy [ 22 ]. Another cohort study showed the association of hip fracture and higher mortality in RA patients (1-year mortality rates18.47% vs. 6.16%) [ 23 ]. According to these findings, how to prevent, detect and manage comorbidities properly has become a vital issue in the long-term management of RA patients.…”

Section: Discussionmentioning

confidence: 99%

Chinese Registry of rheumatoid arthritis (CREDIT): II. prevalence and risk factors of major comorbidities in Chinese patients with rheumatoid arthritis

Jin

Fang³

et al. 2017

Arthritis Res Ther

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Background: Rheumatoid arthritis patients are at higher risk of developing comorbidities. The main objective of this study was to evaluate the prevalence of major comorbidities in Chinese rheumatoid arthritis patients. We also aimed to identify factors associated with these comorbidities. Methods: Baseline demographic, clinical characteristics and comorbidity data from RA patients enrolled in the Chinese Registry of rhEumatoiD arthrITis (CREDIT) from Nov 2016 to August 2017 were presented and compared with those from five other registries across the world. Possible factors related to three major comorbidities (cardiovascular disease, fragility fracture and malignancy) were identified using multivariate logistic regression analyses. Results: A total of 13,210 RA patients were included (80.6% female, mean age 52.9 years and median RA duration 4.0 years). Baseline prevalence rates of major comorbidities were calculated: CVD, 2.2% (95% CI 2.0-2.5%); fragility fracture, 1.7% (95% CI 1.5-1.9%); malignancy, 0.6% (95% CI 0.5-0.7%); overall major comorbidities, 4.2% (95% CI 3.9-4.6%). Advanced age was associated with all comorbidities. Male gender and disease duration were positively related to CVD. Female sex and longer disease duration were potential risk factors for fragility fractures. Ever use of methotrexate (MTX) was negatively related to baseline comorbidities. Conclusions: Patients with rheumatoid arthritis in China have similar prevalence of comorbidities with other Asian countries. Advanced age and long disease duration are possible risk factors for comorbidities. On the contrary, MTX may protect RA patients from several major comorbidities, supporting its central role in the management of rheumatoid arthritis.

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Section: Discussionmentioning

confidence: 99%

Chinese Registry of rheumatoid arthritis (CREDIT): II. prevalence and risk factors of major comorbidities in Chinese patients with rheumatoid arthritis

Jin

Fang³

et al. 2017

Arthritis Res Ther

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“…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. The incident osteoporotic fractures and related costs are estimated to exceed 3 billion and US$25 billion per year, respectively, in the US general population by 2025 4.…”

Section: Introductionmentioning

confidence: 99%

Medications associated with fracture risk in patients with rheumatoid arthritis

et al. 2019

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ObjectiveTo examine the fracture risk with use of disease-modifying antirheumatic drugs (DMARDs), statins, proton pump inhibitors (PPIs), opioids, non-opioid analgesics and psychotropic medications in a US-wide observational rheumatoid arthritis (RA) cohort.MethodsPatients with RA without prior fracture from 2001 through 2017 in FORWARD, a longitudinal observational registry, were assessed for osteoporosis-related site fractures (vertebra, hip, forearm and humerus). DMARD exposure was assessed in four mutually exclusive groups: (1) methotrexate monotherapy-reference, (2) tumour necrosis factor-α inhibitors (TNFi), (3) non-TNFi biologics and (4) others. Non-DMARDs and glucocorticoids were classified as current/ever use and based on treatment duration. Fracture Risk Assessment Tool (FRAX) scores estimating for 10-year major osteoporotic fractures were calculated. Cox proportional hazard models stratified by FRAX were used to adjust for confounders.ResultsDuring median (IQR) 3.0 (1.5–6.0) years of follow-up in 11 412 patients, 914 fractures were observed. The adjusted models showed a significant fracture risk increase with use of any dose glucocorticoids ≥3 months (HR (95% CI) for <7.5 mg/day 1.26 (1.07 to 1.48) and for ≥7.5 mg/day 1.57 (1.27 to 1.94)), opioids (for weak: 1.37 (1.18 to 1.59); strong: 1.53 (1.24 to 1.88)) and selective serotonin reuptake inhibitors (SSRIs) (1.37 (1.15 to 1.63)). Fracture risk with opioids increased within 1 month of use (1.66 (1.36 to 2.04)) and with SSRIs >3 months of use (1.25 (1.01 to 1.55)). Statins (0.77 (0.62 to 0.96)) and TNFi (0.72 (0.54 to 0.97)) were associated with reduction in vertebral fracture risk only. PPIs and other psychotropic medications were not associated with increased fracture risk.ConclusionUse of opioids, SSRIs and glucocorticoids were associated with increased risk of any fracture in patients with RA, whereas statins and TNFi were associated with decreased vertebral fractures.

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“…Nonsurgical complications include readmissions and mortality . Most at risk are patients with such comorbidities as diabetes (DM), liver cirrhosis, and rheumatoid arthritis . Improving surgical outcomes begins with establishing the relationship between these potential risk factors and hip fracture fixation surgery.…”

Section: Introductionmentioning

confidence: 99%

Chronic Kidney Disease Worsens Health Outcomes in Diabetic Patients After Hip Fracture Surgery: An Asian Nationwide Population-Based Cohort Study

Huang

Chen

Lin

et al. 2019

Journal of Bone and Mineral Research

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There is an increased tendency for hip fractures in patients with chronic kidney disease (CKD). Although surgery is the mainstay of treatment for hip fractures, there is scant information on outcomes after hip fracture surgery in diabetic patients at different stages of CKD. In this population‐based cohort study, we compared the surgical outcome, readmission, and mortality rates after osteosynthesis of hip fractures in diabetic patients with different stages of renal function. Diabetic patients who received primary osteosynthesis for hip fracture between January 1997 and December 2013 were enrolled. The primary outcomes were surgical outcomes, including infection and revision surgery. The secondary outcomes were all‐cause readmission and mortality. This study included 44,065 patients; 11,954 had CKD (diabetic CKD group), 1662 patients were receiving dialysis (diabetic dialysis group), and 30,449 patients had no CKD (diabetic non‐CKD group). We found that the diabetic dialysis group had a significantly higher risk of infection and revision surgery compared with diabetic non‐CKD patients (HR = 1.52, 95% CI, 1.24 to 1.87; HR = 1.62, 95% CI, 1.33 to 1.97, respectively, both P < 0.001) and diabetic CKD patients (HR = 1.62, 95% CI, 1.32 to 1.99; HR = 1.48, 95% CI, 1.22 to 1.80, respectively, both P < 0.001). Diabetic CKD patients had a comparable risk of surgical complications including infection and revision as diabetic non‐CKD patients. For readmission and mortality, the diabetic dialysis group had the highest risk among the three groups at all time‐points (3 months after surgery, 1 year, and the last follow‐up, all P < 0.001). Compared with the diabetic non‐CKD group, the diabetic CKD group had an elevated risk of readmission and mortality at all time‐points (all P < 0.001). In conclusion, CKD was associated with worse outcomes after hip fracture fixation surgery. Although at significantly higher risk of readmission and mortality, CKD patients still had a comparable risk of infection and revision to non‐CKD patients. © 2019 American Society for Bone and Mineral Research.

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Rheumatoid arthritis patients with hip fracture: a nationwide study

Cited by 41 publications

References 30 publications

Chinese Registry of rheumatoid arthritis (CREDIT): II. prevalence and risk factors of major comorbidities in Chinese patients with rheumatoid arthritis

Chinese Registry of rheumatoid arthritis (CREDIT): II. prevalence and risk factors of major comorbidities in Chinese patients with rheumatoid arthritis

Medications associated with fracture risk in patients with rheumatoid arthritis

Chronic Kidney Disease Worsens Health Outcomes in Diabetic Patients After Hip Fracture Surgery: An Asian Nationwide Population-Based Cohort Study

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