title: Ten-year incidences of self-reported non-vertebral fractures in Japanese patients with rheumatoid arthritis: discrepancy between disease activity control and the incidence of non-vertebral fracture.
abstract: Despite improvements in rheumatoid arthritis disease activity of in the past 10 years, the incidence of self-reported non-vertebral fractures did not decrease in our cohort of 9,987 patients. This study may indicate that osteoporosis treatment and non-vertebral fracture prevention remain important regardless of the rheumatoid arthritis disease activity.
  
  
  BACKGROUND
  Although rheumatoid arthritis (RA) is a risk factor for osteoporosis and fractures, few studies have described the association between disease activity and the fracture incidence in patients with RA. This study aimed to investigate changes in the non-vertebral fracture incidence between 2001 and 2010 in our Institute of Rheumatology Rheumatoid Arthritis (IORRA) cohort.
  
  
  METHODS
  The IORRA is a prospective observational cohort study of Japanese RA patients. A total of 9,987 patients with RA were enrolled in this cohort from 2000 to 2010. The clinical parameter and non-vertebral fracture occurrence data were collected biannually through self-reported questionnaires. Incidences of self-reported non-vertebral fractures were also analyzed via standardization according to gender, age, and disease activity during each 2-year period.
  
  
  RESULTS
  From 2001 to 2010, the percentage of patients with 28-joint disease activity score remission increased from 7.8 to 39.7%, prednisolone intake decreased from 51.4 to 41.3%, and bisphosphonate intake increased from 5.0 to 23.4%. The non-vertebral fracture incidence rates were 24.6/1,000 person-years in 2001 and 35.5/1,000 person-years in 2010, with no apparent change even after standardization. The overall non-vertebral fracture incidence was significantly higher in the autumn/winter than in the spring/summer (p = 0.02).
  
  
  CONCLUSIONS
  Despite improvements in disease activity and functional disability, the non-vertebral fracture incidence exhibited no apparent change between 2001 and 2010 in our patients with RA. Osteoporosis treatment and non-vertebral fracture prevention remain important regardless of the disease control in patients with RA.
authors.affiliation: Department of Orthopedic Surgery, Institute of Rheumatology, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan, ochi@1998.jukuin.keio.ac.jp.
authors.forename: K
authors.initials: K
authors.lastname: Ochi
authors.forename: E
authors.initials: E
authors.lastname: Inoue
authors.forename: T
authors.initials: T
authors.lastname: Furuya
authors.forename: K
authors.initials: K
authors.lastname: Ikari
authors.forename: Y
authors.initials: Y
authors.lastname: Toyama
authors.forename: A
authors.initials: A
authors.lastname: Taniguchi
authors.forename: H
authors.initials: H
authors.lastname: Yamanaka
authors.forename: S
authors.initials: S
authors.lastname: Momohara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy / Q000209:etiology; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D011446:Prospective Studies; D012621:Seasons; D057566:Self Report; D012720:Severity of Illness Index
chemical_list: D018501:Antirheumatic Agents; D050071:Bone Density Conservation Agents; D005938:Glucocorticoids