title: Characteristics of fracture and related factors in patients with rheumatoid arthritis.
abstract: To examine the clinical features of vertebral and non-vertebral fractures in patients with rheumatoid arthritis (RA), including insufficiency fractures, and to assess the risk factors for fracture, we prospectively studied 209 outpatients with rheumatoid arthritis for 1 year. The age, gender, Steinbrocker's functional class, glucocorticoid use, history of lower limb surgery, serum C-reactive protein (CRP), and use of bisphosphonates were evaluated. Examination for fractures was performed by radiography, computed tomography (CT), magnetic resonance imaging (MRI), and bone scanning. Thirty-three fractures occurred in 24 patients over the 1-year study period, and the incidence was 15.8 fractures per 100 patient-years. Fractures occurred at various sites. The majority (70%) was insufficiency fracture, and more than 50% caused ambulatory dysfunction. Radiographic findings were absent in 39% of the fractures at the onset of pain. The functional class and glucocorticoid dose were significantly associated with fracture development. This prospective study showed that the incidence of fractures, especially insufficiency fractures, was very high in patients with rheumatoid arthritis and that most of their fractures caused gait disturbance. Early intervention to prevent secondary osteoporosis is recommended to maintain the quality of life in patients with rheumatoid arthritis, especially those with functional impairment or undergoing glucocorticoid therapy.
authors.affiliation: Department of Orthopaedics, Osaka University Graduate School of Medicine, Suita, Japan.
authors.forename: Akihide
authors.initials: A
authors.lastname: Nampei
authors.forename: Jun
authors.initials: J
authors.lastname: Hashimoto
authors.forename: Junichiro
authors.initials: J
authors.lastname: Koyanagi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ono
authors.forename: Hideo
authors.initials: H
authors.lastname: Hashimoto
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Tsumaki
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Tomita
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Sugamoto
authors.forename: Norihiro
authors.initials: N
authors.lastname: Nishimoto
authors.forename: Takahiro
authors.initials: T
authors.lastname: Ochi
authors.forename: Hideki
authors.initials: H
authors.lastname: Yoshikawa
mesh_terms: D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D004164:Diphosphonates / Q000627:therapeutic use; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D005598:Fractures, Spontaneous / Q000453:epidemiology / Q000209:etiology; D015775:Fractures, Stress / Q000453:epidemiology / Q000209:etiology; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D004164:Diphosphonates; D005938:Glucocorticoids