Are young women and men with rheumatoid arthritis at risk for fragility fractures? A population-based study.
OBJECTIVE
Older women and men with rheumatoid arthritis (RA) are at increased risk for fractures, but limited information is available on fracture risk in younger individuals with RA and whether such risk occurs early in the disease onset or only when older. We determined the risk for fractures in both young and older women and men following RA diagnosis.


METHODS
We studied a population-based inception cohort with RA from Olmsted County, Minnesota, USA. We identified 822 women and 349 men diagnosed with RA between 1955 and 2007 (308 women and 110 men diagnosed before age 50) and an equal number of paired non-RA subjects, matched by sex and birth year. Incident fractures were collected through review of complete (inpatient and outpatient) medical records available through the linkage system of the Rochester Epidemiology Project.


RESULTS
The hazard ratio (HR; 95% CI) for a non-pathologic fracture occurring from no more than moderate trauma was 1.63 (1.36-1.96) for women and 1.40 (1.02-1.93) for men with RA. Findings were consistent for women and men diagnosed with RA at age ≥ 50 years [HR, 1.43 (1.16-1.77) and 1.34 (0.92-1.94), respectively], or at age < 50 years [HR, 2.34 (1.61-3.42) and 1.74 (0.91-3.30), respectively]. However, young women, but not young men, with RA were at increased fracture risk even before age 50 years (HR, 1.95 [1.08-3.51] and 0.82 [0.28-2.45], respectively).


CONCLUSIONS
Young men with RA are at increased risk for fractures only when older, whereas young women with RA have an elevated fracture risk even while still young.
From the Department of Medicine, Divisions of Rheumatology and Endocrinology, Diabetes, Metabolism and Nutrition; and Department of Health Sciences Research, Divisions of Epidemiology and Biomedical Statistics and Informatics, College of Medicine, Mayo Clinic, Rochester, MN, USA.
Shreyasee
S
Amin
Sherine E
SE
Gabriel
Sara J
SJ
Achenbach
Elizabeth J
EJ
Atkinson
L Joseph
LJ
Melton
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000453:epidemiology*; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012306:Risk
BONE FRACTURES; EPIDEMIOLOGY; OSTEOPOROSIS; RHEUMATOID ARTHRITIS