title: The risk of fracture among patients with psoriatic arthritis and psoriasis: a population-based study.
abstract: OBJECTIVE
  To determine the risk of fracture and osteoporosis among patients with psoriatic arthritis (PsA) and psoriasis, compared with the general population and patients with rheumatoid arthritis (RA).
  
  
  METHODS
  A population-based cohort study was performed in The Health Improvement Network in the UK using data from 1994 to 2014. Patients aged 18-89 years with PsA or psoriasis and up to five unexposed controls matched by practice and start date within that practice were included. Patients with RA and matched controls were included for comparison. Severe psoriasis was defined by a code for psoriasis and either phototherapy or a systemic medication for psoriasis. Incidence and adjusted HRs (aHR) for fracture (all, hip, vertebral) were calculated.
  
  
  RESULTS
  Patients with PsA (n=9788), psoriasis (n=158 323) and controls (n=821 834) were identified. Patients with PsA had an elevated risk of all fracture aHR 1.26 (1.06 to 1.27). Patients with mild psoriasis had elevated risk of all fractures, vertebral and hip fracture: aHR 1.07 (1.05 to 1.10), 1.17 (1.03 to 1.33) and 1.13 (1.04 to 1.22). Patients with severe psoriasis had significantly elevated risk of all fracture and vertebral fracture: aHR 1.26 (1.15 to 1.39) and 2.23 (1.54 to 3.22).
  
  
  CONCLUSIONS
  PsA and psoriasis are associated with an elevated risk for fracture.
authors.affiliation: Division of Rheumatology, Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Alexis
authors.initials: A
authors.lastname: Ogdie
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Harter
authors.affiliation: Department of Dermatology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Shin
authors.affiliation: Division of Rheumatology, Philadelphia Veterans Administration Medical Center, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Baker
authors.affiliation: Department of Dermatology, Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Junko
authors.initials: J
authors.lastname: Takeshita
authors.affiliation: Division of Rheumatology and Allergy/Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Hyon K
authors.initials: HK
authors.lastname: Choi
authors.affiliation: Division of Rheumatology, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland.
authors.forename: Thorvardur Jon
authors.initials: TJ
authors.lastname: Love
authors.affiliation: Department of Dermatology, Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gelfand
mesh_terms: D000328:Adult; D000368:Aged; D015535:Arthritis, Psoriatic / Q000453:epidemiology / Q000628:therapy; D001172:Arthritis, Rheumatoid / Q000453:epidemiology; D016022:Case-Control Studies; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D006620:Hip Fractures / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology*; D011565:Psoriasis / Q000453:epidemiology* / Q000628:therapy; D018570:Risk Assessment; D012720:Severity of Illness Index; D016103:Spinal Fractures / Q000453:epidemiology; D006113:United Kingdom / Q000453:epidemiology
keywords: Epidemiology; Osteoporosis; Psoriatic Arthritis; Rheumatoid Arthritis