nach oben

Clinical Rheumatology

Erschienen in:

10.01.2022 | Original Article

Incidence and risk factors for vertebral fracture in rheumatoid arthritis: an update meta-analysis

verfasst von: Yang Liu, Jun Jiang, Minmin Mo, Xiaohong Sun, Kailong Yu

Erschienen in: Clinical Rheumatology | Ausgabe 5/2022

Einloggen, um Zugang zu erhalten

Abstract

Objectives

This study was conducted to investigate the prevalence of vertebral fracture (VF) and its risk in patients with rheumatoid arthritis (RA) as compared to healthy individuals, and to explore the underlying risk factors.

Methods

The electronic databases of PubMed, EMBASE, and the Cochrane Library were applied to search for the relevant literatures, which reported the prevalence of VF in both RA patients and healthy controls (up to Mar 31, 2021). The non-weighted prevalence of VF, pooled estimates of odds ratio (OR), and its 95% confidence intervals (CI) were calculated with the use of random-effects model; between-study heterogeneity was evaluated by Cochrane Q statistic, then was quantified with I². Publication bias was evaluated using Egger’s linear regression test.

Results

A number of 867 literatures were identified after searching for online databases, based on the inclusion and exclusion criteria, 11 eligible studies, which comprising 3805 RA patients and 59,517 healthy participants, were finally incorporated in meta-analysis. The results showed that RA patients had an increased prevalence of VF (20.29 vs 8.63%), and an elevated risk for VF (OR = 3.04, 95% CI 1.97–4.71) as compared to healthy population. Additional subgroup analysis suggested that age, body mass index (BMI), disease activity, and drug therapy might be associated with risk of VF in RA.

Conclusions

Overall, our study demonstrated an increased risk of VF in patients with RA, suggesting that age, race, BMI, disease activity, and drug therapy may be represented as risk factors contributing to the occurrence of VF in RA.

Key Points

• RA patients had the increased prevalence and risk of vertebral fracture (VF) as compared to healthy population.

• Age, race, BMI, disease activity, and drug therapy might be associated with VF in RA.

• Our findings would be helpful for the early evaluation of RA patients with high VF risk.

Nur mit Berechtigung zugänglich

Singh JA, Saag KG, Bridges SL Jr et al (2016) 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Rheumatol 68(1):1–26. https://doi.org/10.1002/art.39480CrossRefPubMed

Kroot EJ, Nieuwenhuizen MG, de Waal Malefijt MC et al (2001) Change in bone mineral density in patients with rheumatoid arthritis during the first decade of the disease. Arthritis Rheum 44(6):1254–1260. https://doi.org/10.1002/1529-0131(200106)44:6%3c1254::AID-ART216%3e3.0.CO;2-GCrossRefPubMed

Rudan I, Sidhu S, Papana A et al (2015) Prevalence of rheumatoid arthritis in low- and middle-income countries: a systematic review and analysis. J Glob Health 5(1):010409. https://doi.org/10.7189/jogh.05.010409CrossRefPubMedPubMedCentral

Usenbo A, Kramer V, Young T et al (2015) Prevalence of arthritis in Africa: a systematic review and meta-analysis. PLoS ONE 10(8):e0133858. https://doi.org/10.1371/journal.pone.0133858CrossRefPubMedPubMedCentral

Kochi Y (2010) Genetic background of tolerance breakdown in rheumatoid arthritis. Nihon Rinsho Meneki Gakkai Kaishi 33(2):48–56. https://doi.org/10.2177/jsci.33.48CrossRefPubMed

Alpizar-Rodriguez D, Finckh A (2017) Environmental factors and hormones in the development of rheumatoid arthritis. Semin Immunopathol 39(4):461–468. https://doi.org/10.1007/s00281-017-0624-2CrossRefPubMed

Deodhar AA, Woolf AD (1996) Bone mass measurement and bone metabolism in rheumatoid arthritis: a review. Br J Rheumatol 35(4):309–322. https://doi.org/10.1093/rheumatology/35.4.309CrossRefPubMed

Xue AL, Wu SY, Jiang L et al (2017) Bone fracture risk in patients with rheumatoid arthritis: a meta-analysis. Medicine (Baltimore) 96(36):e6983. https://doi.org/10.1097/MD.0000000000006983CrossRef

Roux C (2011) Osteoporosis in inflammatory joint diseases. Osteoporos Int 22(2):421–433. https://doi.org/10.1007/s00198-010-1319-xCrossRefPubMed

10.

Vosse D, de Vlam K (2009) Osteoporosis in rheumatoid arthritis and ankylosing spondylitis. Clin Exp Rheumatol 27(4 Suppl 55):S62–S67PubMed

11.

Ghazi M, Kolta S, Briot K et al (2012) Prevalence of vertebral fractures in patients with rheumatoid arthritis: revisiting the role of glucocorticoids. Osteoporos Int 23(2):581–587. https://doi.org/10.1007/s00198-011-1584-3CrossRefPubMed

12.

van Staa TP, Geusens P, Bijlsma JW et al (2006) Clinical assessment of the long-term risk of fracture in patients with rheumatoid arthritis. Arthritis Rheum 54(10):3104–3112. https://doi.org/10.1002/art.22117CrossRefPubMed

13.

Tong JJ, Xu SQ, Zong HX et al (2020) Prevalence and risk factors associated with vertebral osteoporotic fractures in patients with rheumatoid arthritis. Clin Rheumatol 39(2):357–364. https://doi.org/10.1007/s10067-019-04787-9CrossRefPubMed

14.

Arai K, Hanyu T, Sugitani H et al (2006) Risk factors for vertebral fracture in menopausal or postmenopausal Japanese women with rheumatoid arthritis: a cross-sectional and longitudinal study. J Bone Miner Metab 24(2):118–124. https://doi.org/10.1007/s00774-005-0657-9CrossRefPubMed

15.

Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62(10):1006–1012. https://doi.org/10.1016/j.jclinepi.2009.06.005CrossRefPubMed

16.

Robert K, Pages C, Ledru A et al (2005) Regulation of extracellular signal-regulated kinase by homocysteine in hippocampus. Neuroscience 133(4):925–935. https://doi.org/10.1016/j.neuroscience.2005.03.034CrossRefPubMed

17.

Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11):1539–1558. https://doi.org/10.1002/sim.1186CrossRefPubMed

18.

Higgins JP, Thompson SG, Deeks JJ et al (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560CrossRef

19.

Egger M, Davey Smith G, Schneider M et al (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634CrossRef

20.

Guañabens N, Olmos JM, Hernandez JL et al (2021) Vertebral fractures are increased in rheumatoid arthritis despite recent therapeutic advances: a case-control study. Osteoporos Int 32(7):1333–1342. https://doi.org/10.1007/s00198-021-05824-7CrossRefPubMed

21.

Chen YF, Zong HX, Xu SQ et al (2021) Synergistic effect of sarcopenia and poor balance on osteoporotic vertebral fracture in Chinese patients with rheumatoid arthritis. Clin Rheumatol. https://doi.org/10.1007/s10067-021-05703-wCrossRefPubMedPubMedCentral

22.

Pierini FS, Brom M, Scolnik M et al (2021) Osteoporotic fractures in rheumatoid arthritis patients in Argentina: a matched retrospective cohort study. Adv Rheumatol 61(1):21. https://doi.org/10.1186/s42358-021-00179-3CrossRefPubMed

23.

Kim HA, Lee HY, Jung JY et al (2020) Trabecular bone score is a useful parameter for the prediction of vertebral fractures in patients with polymyalgia rheumatica. J Clin Densitom 23(3):373–380. https://doi.org/10.1016/j.jocd.2019.05.006CrossRefPubMed

24.

Fauny M, Albuisson E, Bauer E et al (2019) Study of vertebral fracture and Scanographic Bone Attenuation Coefficient in rheumatoid arthritis and ankylosing spondylitis vs. controls. Sci Rep 9(1):13323. https://doi.org/10.1038/s41598-019-49712-xCrossRefPubMedPubMedCentral

25.

Okano T, Inui K, Tada M et al (2017) High frequency of vertebral fracture and low bone quality in patients with rheumatoid arthritis-Results from TOMORROW study. Mod Rheumatol 27(3):398–404. https://doi.org/10.1080/14397595.2016.1213943CrossRefPubMed

26.

Liu W, Xu S, Ma X et al (2014) Exploration of risk factors on the occurrence of osteoporotic vertebral fracture in patients with rheumatoid arthritis. Zhonghua Nei Ke Za Zhi 53(11):852–857PubMed

27.

Brennan SL, Toomey L, Kotowicz MA et al (2014) Rheumatoid arthritis and incident fracture in women: a case-control study. BMC Musculoskelet Disord 15:13. https://doi.org/10.1186/1471-2474-15-13CrossRefPubMedPubMedCentral

28.

Palma S, Delgado-Rodriguez M (2005) Assessment of publication bias in meta-analyses of cardiovascular diseases. J Epidemiol Community Health 59(10):864–9. 59/10/864 [pii] https://doi.org/10.1136/jech.2005.033027

29.

Goldring SR (2015) Inflammatory signaling induced bone loss. Bone 80:143–149. https://doi.org/10.1016/j.bone.2015.05.024CrossRefPubMed

30.

Heinlen L, Humphrey MB (2017) Skeletal complications of rheumatoid arthritis. Osteoporos Int 28(10):2801–2812. https://doi.org/10.1007/s00198-017-4170-5CrossRefPubMed

31.

Jin S, Hsieh E, Peng L et al (2018) Incidence of fractures among patients with rheumatoid arthritis: a systematic review and meta-analysis. Osteoporos Int 29(6):1263–1275. https://doi.org/10.1007/s00198-018-4473-1CrossRefPubMed

32.

Ursum J, Britsemmer K, van Schaardenburg D et al (2009) High prevalence of vertebral deformities in elderly patients with early rheumatoid arthritis. Ann Rheum Dis 68(9):1512–1513. https://doi.org/10.1136/ard.2008.105957CrossRefPubMed

33.

O’Brien CA, Jia D, Plotkin LI et al (2004) Glucocorticoids act directly on osteoblasts and osteocytes to induce their apoptosis and reduce bone formation and strength. Endocrinology 145(4):1835–1841. https://doi.org/10.1210/en.2003-0990CrossRefPubMed

34.

Sparks JA (2019) Rheumatoid arthritis. Ann Intern Med 170(1):ITC1–ITC16. https://doi.org/10.7326/AITC201901010CrossRefPubMed

35.

di Munno O, Mazzantini M, Sinigaglia L et al (2004) Effect of low dose methotrexate on bone density in women with rheumatoid arthritis: results from a multicenter cross-sectional study. J Rheumatol 31(7):1305–1309PubMed

36.

Buckley LM, Leib ES, Cartularo KS et al (1997) Effects of low dose methotrexate on the bone mineral density of patients with rheumatoid arthritis. J Rheumatol 24(8):1489–1494PubMed

37.

Bologna C, Edno L, Anaya JM et al (1994) Methotrexate concentrations in synovial membrane and trabecular and cortical bone in rheumatoid arthritis patients. Arthritis Rheum 37(12):1770–1773. https://doi.org/10.1002/art.1780371210CrossRefPubMed

38.

May KP, West SG, McDermott MT et al (1994) The effect of low-dose methotrexate on bone metabolism and histomorphometry in rats. Arthritis Rheum 37(2):201–206. https://doi.org/10.1002/art.1780370208CrossRefPubMed

39.

Westhovens R, Dequeker J (2000) Rheumatoid arthritis and osteoporosis. Z Rheumatol 59(Suppl 1):33–38. https://doi.org/10.1007/s003930070036CrossRefPubMed

40.

Kwon OC, Oh JS, Hong S et al (2019) Conventional synthetic disease-modifying antirheumatic drugs and bone mineral density in rheumatoid arthritis patients with osteoporosis: possible beneficial effect of leflunomide. Clin Exp Rheumatol 37(5):813–819PubMed

41.

Vis M, Wolbink GJ, Lodder MC et al (2003) Early changes in bone metabolism in rheumatoid arthritis patients treated with infliximab. Arthritis Rheum 48(10):2996–2997. https://doi.org/10.1002/art.11292CrossRefPubMed

42.

Zerbini CAF, Clark P, Mendez-Sanchez L et al (2017) Biologic therapies and bone loss in rheumatoid arthritis. Osteoporos Int 28(2):429–446. https://doi.org/10.1007/s00198-016-3769-2CrossRefPubMed

43.

Ozen G, Pedro S, Wolfe F et al (2019) Medications associated with fracture risk in patients with rheumatoid arthritis. Ann Rheum Dis 78(8):1041–1047. https://doi.org/10.1136/annrheumdis-2019-215328CrossRefPubMed

44.

Coulson KA, Reed G, Gilliam BE et al (2009) Factors influencing fracture risk, T score, and management of osteoporosis in patients with rheumatoid arthritis in the Consortium of Rheumatology Researchers of North America (CORRONA) registry. J Clin Rheumatol 15(4):155–160. https://doi.org/10.1097/RHU.0b013e3181a5679dCrossRefPubMed

45.

Malysheva K, de Rooij K, Lowik CW et al (2016) Interleukin 6/Wnt interactions in rheumatoid arthritis: interleukin 6 inhibits Wnt signaling in synovial fibroblasts and osteoblasts. Croat Med J 57(2):89–98. https://doi.org/10.3325/cmj.2016.57.89CrossRefPubMedPubMedCentral

46.

Briot K, Rouanet S, Schaeverbeke T et al (2015) The effect of tocilizumab on bone mineral density, serum levels of Dickkopf-1 and bone remodeling markers in patients with rheumatoid arthritis. Joint Bone Spine 82(2):109–115. https://doi.org/10.1016/j.jbspin.2014.10.015CrossRefPubMed

47.

Abu-Shakra M, Zisman D, Balbir-Gurman A et al (2018) Effect of tocilizumab on fatigue and bone mineral density in patients with rheumatoid arthritis. Isr Med Assoc J 20(4):239–244PubMed

48.

Chen YM, Chen HH, Huang WN et al (2017) Tocilizumab potentially prevents bone loss in patients with anticitrullinated protein antibody-positive rheumatoid arthritis. PLoS ONE 12(11):e0188454. https://doi.org/10.1371/journal.pone.0188454CrossRefPubMedPubMedCentral

49.

Murakami K, Kobayashi Y, Uehara S et al (2017) A Jak1/2 inhibitor, baricitinib, inhibits osteoclastogenesis by suppressing RANKL expression in osteoblasts in vitro. PLoS ONE 12(7):e0181126. https://doi.org/10.1371/journal.pone.0181126CrossRefPubMedPubMedCentral

Titel: Incidence and risk factors for vertebral fracture in rheumatoid arthritis: an update meta-analysis
verfasst von: Yang Liu
Jun Jiang
Minmin Mo
Xiaohong Sun
Kailong Yu
Publikationsdatum: 10.01.2022
Verlag: Springer International Publishing
Erschienen in: Clinical Rheumatology / Ausgabe 5/2022
Print ISSN: 0770-3198
Elektronische ISSN: 1434-9949
DOI: https://doi.org/10.1007/s10067-021-06046-2

Assessing the burden of osteoarthritis in Latin America: a rapid evidence assessment

Open Access
Review Article

Annexin A1 and its receptor gene polymorphisms in systemic lupus erythematosus in the Tunisian population

Original Article

Anxiety levels before biologic initiation and changes with treatment in patients with psoriatic arthritis: HUR-BIO biologic registry results

Original Article

Asymptomatic SARS-CoV-2 seropositivity: patients with childhood-onset rheumatic diseases versus healthy children

Zur Zeit gratis
COVID-19
Original Article

The impact of anti-TNF treatment on Wnt signaling, noggin, and cytokine levels in axial spondyloarthritis

Original Article

Indications and risk factors for hospitalization in patients with primary Sjögren syndrome: experience from a tertiary center in Turkey

Original Article

Kompaktes Leitlinien-Wissen Innere Medizin (Link öffnet in neuem Fenster)

Mit medbee Pocketcards schnell und sicher entscheiden.
Leitlinien-Wissen kostenlos und immer griffbereit auf ihrem Desktop, Handy oder Tablet.

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Schützt das tägliche Glas Milch vor Darmkrebs?

17.01.2025
Kolorektales Karzinom
Nachrichten

Die Milch machts – sie bietet Frauen nach Daten einer großen Ernährungsanalyse den besten Darmkrebsschutz aller Lebensmittel, was am hohen Kalziumgehalt liegen dürfte. Am anderen Ende des Spektrums steht der Alkoholkonsum: Das Glas Wein am Abend ist eher ungünstig.

Vorsicht mit Glukokortikoiden bei Glomerulopathie

16.01.2025
Primäre Glomerulonephritiden
Nachrichten

Auch niedrig dosierte Glukokortikoide zur Behandlung einer primären Glomerulopathie lassen offenbar die Infektionsgefahr steigen. In einer US-Studie hing das Risiko vor allem mit der kombinierten Anwendung von Immunsuppressiva zusammen.

KI-gestütztes Mammografiescreening überzeugt im Praxistest

16.01.2025
Künstliche Intelligenz im Gesundheitswesen
Nachrichten

Mit dem Einsatz künstlicher Intelligenz lässt sich die Detektionsrate im Mammografiescreening offenbar deutlich steigern. Mehr unnötige Zusatzuntersuchungen sind laut der Studie aus Deutschland nicht zu befürchten.

Welche Krebserkrankungen bei Zöliakie häufiger auftreten

16.01.2025
Zöliakie
Nachrichten

Eine große Kohortenstudie hat den Zusammenhang zwischen Zöliakie und gastrointestinalen Krebserkrankungen und inflammatorischen Krankheiten untersucht. Neben gastrointestinalen Tumoren ist auch ein nicht solider Krebs häufiger.

EKG Essentials: EKG befunden mit System (Link öffnet in neuem Fenster)

In diesem CME-Kurs können Sie Ihr Wissen zur EKG-Befundung anhand von zwölf Video-Tutorials auffrischen und 10 CME-Punkte sammeln.
Praxisnah, relevant und mit vielen Tipps & Tricks vom Profi.

Jetzt 10 CME-Punkte sammeln

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Incidence and risk factors for vertebral fracture in rheumatoid arthritis: an update meta-analysis