title: Clinical assessment of the long-term risk of fracture in patients with rheumatoid arthritis.
abstract: OBJECTIVE
  To determine whether patients with rheumatoid arthritis (RA) have an increased risk of fracture, and to estimate their long-term absolute fracture risk.
  
  
  METHODS
  We studied patients with RA ages >or=40 years in the British General Practice Research Database, each matched by age, sex, calendar time, and practice to 3 control patients. Incident fractures, as recorded in the computerized medical records, were ascertained over a median followup of 7.6 years. The fracture rate in RA patients compared with controls was adjusted for smoking, body mass index (BMI), and several clinical risk factors, and Cox proportional hazards models were used to calculate the relative risk (RR) of fracture in RA. A risk score was then developed to provide an estimate of the 5- and 10-year fracture risk among RA patients.
  
  
  RESULTS
  There were 30,262 patients with RA, of whom 2,460 experienced a fracture during followup. Compared with controls, patients with RA had an increased risk of fracture, which was most marked at the hip (RR 2.0, 95% confidence interval [95% CI] 1.8-2.3) and spine (RR 2.4, 95% CI 2.0-2.8). Indicators of a substantially elevated risk of fracture (at the hip) included >10 years' duration of RA (RR 3.4, 95% CI 3.0-3.9), low BMI (RR 3.9, 95% CI 3.1-4.9), and use of oral glucocorticoids (RR 3.4, 95% CI 3.0-4.0). Modeling of the long-term risk profiles revealed that, for example, in a woman age 65 years with longstanding RA whose risk factors also included low BMI, a history of fracture, and frequent use of oral glucocorticoids, the 5-year risk of hip fracture was 5.7% (95% CI 5.3-6.1%).
  
  
  CONCLUSIONS
  Patients with RA are at increased risk of osteoporotic fractures. This increased risk is attributable to a combination of disease activity and use of oral glucocorticoids.
authors.affiliation: MRC Epidemiology Resource Centre, University of Southampton, Southampton, UK.
authors.forename: T P
authors.initials: TP
authors.lastname: van Staa
authors.forename: P
authors.initials: P
authors.lastname: Geusens
authors.forename: J W J
authors.initials: JW
authors.lastname: Bijlsma
authors.forename: H G M
authors.initials: HG
authors.lastname: Leufkens
authors.forename: C
authors.initials: C
authors.lastname: Cooper
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000503:physiopathology*; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D050723:Fractures, Bone / Q000209:etiology* / Q000503:physiopathology*; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000503:physiopathology; D012307:Risk Factors; D013997:Time Factors
chemical_list: D005938:Glucocorticoids