Clinical study of osteoporotic fracture in patients with rheumatoid arthritis / 中华风湿病学杂志

ABSTRACT

Objective To investigate the clinical features and related risk factors of osteoporosis (OP) and osteoporotic fracture (OPF) in patients with rheumatoid arthritis (RA).Methods Two hundred and seventytwo in-patients with RA between 2010-2011 were surveyed,X-ray was detected for the diagnosis of fracture.Bone mineral density(BMD) of proximal femur and lumbar vertebrae (L2-4) in 203 patients were measured by dual energy X-ray absorptio-metry (DEXA),and the radiographic changes in both hands of 169 RA patients were assessed by Sharp scoring system.All the clinical and laboratory factors of RA were recorded in detail by rheumatologists.The results of 120 normal people were used as controls.T-test,Mann-whitney test,x2 test and Logistic regression were used for statistical analysis.Results ① Compared to the normal group,the BMDs of RA patients at each measured location were significantly lower (P＜0.01),the OP incidence was 32.0％ (65/203),which was significantly higher than that of the normal group,which was 15.0％ (18/120) (x2=11.442,P=0.001).There were 33 cases of OPF among all 272 RA patients,and the occurrence rate was 12.1％.BMDs of the femur in RA with OPF were lower than those in RA without OPF (P＜0.01).② Incidence of OP in RA with glucoco-rticoid was 42.2％(46/109),which was higher than that in RA without glucocorticoid (20.2％,18/89) (x2=10.818,P=0.001).Compared with RA without glucocorticoid,the incidence of OPF in RA with glucocorticoid elevated evidently [7.2％ (9/125) vs 17.5％ (24/137)] (x2=6.321,P=0.012).③ Logistic regression (back-ward LR method) analysis found that the risk factors for OP in RA patients were age [OR=1.050,P=0.001,95％CI(1.020,1.080)],HAQ [OR=1.966,P=0.031,95％CI (1.064,3.631)],and glucocorticoid average daily dosage [OR=1.075,P=0.031,95％CI (1.007,1.148)].The risk factors for OPF in RA patients were age [OR=1.041,P=0.046,95％CI (1.001,1.084)] and OP [OR=3.484,P=0.016,95％CI (1.258,9.646)].Conclusion RA patients have higher incidence of OP and OPF than general population.The incidence of OP and OPF are closely correlated with age,diseases activity,local bone erosion and the use of glucocorticosteroid.