Risk factors for incident fragility fractures in patients with rheumatoid arthritis: An cohort study based on a nation-wide prospective registry

Abstract

Abstract Objective To identify the risk factors associated with incident fragility fractures in Chinese patients with rheumatoid arthritis (RA). Methods This study was based on the Chinese Registry of rhEumatoiD arthrITis (CREDIT), a nation-wide prospective registry. For each patient with incident fragility fracture, 20 control patients with matched follow-up duration (with < 1 month difference) were randomly selected for analysis using multivariable logistic regression analysis. Results are shown as odds ratio (OR) and 95% confidence interval (CI). Results A total of 11564 patients were screened. Incident fragility fracture occurred in 32 patients (27 women) patients during the median follow-up of 24.5(10.3, 31.8)months. In comparison to the control patients (n = 642; 534 women), patients who developed fragility fractures had older age, higher rate of menopause, longer disease duration, higher rate of morning stiffness, higher number of swollen joints and higher DAS28 CRP at the baseline. The cases also had lower use rate for glucocorticoid, csDMARDs, and calcium-vitamin D supplementation. In multivariable logistic regression, incident fragility fracture was associated with older age (OR: 1.006 per year, 95%CI: 1.001, 1.011), longer disease duration (OR: 1.006 per year, 95%CI: 1.001, 1.011), menopause (OR: 28.411, 95%CI: 3.154, 255.935), and no calcium-vitamin D supplementation (OR: 4.505, 95%CI: 1.414, 14.289). Conclusion Risk factors for incident fragility fracture in RA patients included older age, longer disease duration, menopause and no calcium-vitamin D supplementation.