title: Rheumatoid arthritis and incident fracture in women: a case-control study.
abstract: BACKGROUND
  To examine fracture incidence in women with rheumatoid arthritis (RA) for an entire geographical region of south-eastern Australia.
  
  
  METHODS
  Women aged 35 years and older, resident in the Barwon Statistical Division (BSD) and clinically diagnosed with RA 1994-2001 were eligible for inclusion as cases (n = 1,008). The control population (n = 172,422) comprised the entire female BSD population aged 35 years and older, excluding those individuals identified as cases. Incident fractures were extracted from the prospective Geelong Osteoporosis Study Fracture Grid. We calculated rate ratios (RR) and 95% confidence intervals (CI) to compare the age-adjusted rate of fracture between the RA and non-RA populations, and used a chi-square test to compare proportions of fractures between women with and without RA, and a two-sided Mann-Whitney U-test to examine age-differences.
  
  
  RESULTS
  Among 1,008 women with RA, 19 (1.9%) sustained a fracture, compared to 1,981 fractures sustained by the 172,422 women without RA (1.2%). Fracture rates showed a trend for being greater among women diagnosed with RA (age-adjusted RR 1.43, 95%CI 0.98-2.09, p = 0.08). Women with RA sustained vertebral fractures at twice the expected frequency, whereas hip fractures were underrepresented in the RA population (p < 0.001). RA status was not associated with the likelihood of sustaining a fracture at sites adjacent to joints most commonly affected by RA (p = 0.22).
  
  
  CONCLUSIONS
  Given that women with RA have a greater risk of fracture compared to women without RA, these patients may be a suitable target population for anti-resorptive agents; however, larger studies are warranted.
authors.affiliation: School of Medicine, Deakin University, Geelong, Victoria, Australia. sbrennan@unimelb.edu.au.
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Brennan
authors.forename: Liesje
authors.initials: L
authors.lastname: Toomey
authors.forename: Mark A
authors.initials: MA
authors.lastname: Kotowicz
authors.forename: Margaret J
authors.initials: MJ
authors.lastname: Henry
authors.forename: Hedley
authors.initials: H
authors.lastname: Griffiths
authors.forename: Julie A
authors.initials: JA
authors.lastname: Pasco
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000453:epidemiology*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis / Q000453:epidemiology*; D006620:Hip Fractures / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D016103:Spinal Fractures / Q000453:epidemiology; D013997:Time Factors; D014739:Victoria / Q000453:epidemiology