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Erschienen in: Modern Rheumatology 2/2008

01.04.2008 | Original Article

Characteristics of fracture and related factors in patients with rheumatoid arthritis

verfasst von: Akihide Nampei, Jun Hashimoto, Junichiro Koyanagi, Takeshi Ono, Hideo Hashimoto, Noriyuki Tsumaki, Tetsuya Tomita, Kazuomi Sugamoto, Norihiro Nishimoto, Takahiro Ochi, Hideki Yoshikawa

Erschienen in: Modern Rheumatology | Ausgabe 2/2008

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Abstract

To examine the clinical features of vertebral and non-vertebral fractures in patients with rheumatoid arthritis (RA), including insufficiency fractures, and to assess the risk factors for fracture, we prospectively studied 209 outpatients with rheumatoid arthritis for 1 year. The age, gender, Steinbrocker’s functional class, glucocorticoid use, history of lower limb surgery, serum C-reactive protein (CRP), and use of bisphosphonates were evaluated. Examination for fractures was performed by radiography, computed tomography (CT), magnetic resonance imaging (MRI), and bone scanning. Thirty-three fractures occurred in 24 patients over the 1-year study period, and the incidence was 15.8 fractures per 100 patient-years. Fractures occurred at various sites. The majority (70%) was insufficiency fracture, and more than 50% caused ambulatory dysfunction. Radiographic findings were absent in 39% of the fractures at the onset of pain. The functional class and glucocorticoid dose were significantly associated with fracture development. This prospective study showed that the incidence of fractures, especially insufficiency fractures, was very high in patients with rheumatoid arthritis and that most of their fractures caused gait disturbance. Early intervention to prevent secondary osteoporosis is recommended to maintain the quality of life in patients with rheumatoid arthritis, especially those with functional impairment or undergoing glucocorticoid therapy.
Literatur
1.
Zurück zum Zitat Peel NF, Moore DJ, Barrington NA, Bax DE, Eastell R. Risk of vertebral fracture and relationship to bone mineral density in steroid treated rheumatoid arthritis. Ann Rheum Dis 1995;54:801–6.PubMedCrossRef Peel NF, Moore DJ, Barrington NA, Bax DE, Eastell R. Risk of vertebral fracture and relationship to bone mineral density in steroid treated rheumatoid arthritis. Ann Rheum Dis 1995;54:801–6.PubMedCrossRef
2.
Zurück zum Zitat Spector TD, Hall GM, McCloskey EV, Kanis JA. Risk of vertebral fracture in women with rheumatoid arthritis. BMJ 1993;306:558.PubMed Spector TD, Hall GM, McCloskey EV, Kanis JA. Risk of vertebral fracture in women with rheumatoid arthritis. BMJ 1993;306:558.PubMed
3.
Zurück zum Zitat de Nijs RN, Jacobs JW, Bijlsma JW, Lems WF, Laan RF, Houben HH, et al. Prevalence of vertebral deformities and symptomatic vertebral fractures in corticosteroid treated patients with rheumatoid arthritis. Rheumatology (Oxford) 2001;40:1375–83.CrossRef de Nijs RN, Jacobs JW, Bijlsma JW, Lems WF, Laan RF, Houben HH, et al. Prevalence of vertebral deformities and symptomatic vertebral fractures in corticosteroid treated patients with rheumatoid arthritis. Rheumatology (Oxford) 2001;40:1375–83.CrossRef
4.
Zurück zum Zitat Cooper C, Coupland C, Mitchell M. Rheumatoid arthritis, corticosteroid therapy and hip fracture. Ann Rheum Dis 1995;54:49–52.PubMed Cooper C, Coupland C, Mitchell M. Rheumatoid arthritis, corticosteroid therapy and hip fracture. Ann Rheum Dis 1995;54:49–52.PubMed
5.
Zurück zum Zitat Huusko TM, Korpela M, Karppi P, Avikainen V, Kautiainen H, Sulkava R. Threefold increased risk of hip fractures with rheumatoid arthritis in Central Finland. Ann Rheum Dis 2001;60:521–2.PubMedCrossRef Huusko TM, Korpela M, Karppi P, Avikainen V, Kautiainen H, Sulkava R. Threefold increased risk of hip fractures with rheumatoid arthritis in Central Finland. Ann Rheum Dis 2001;60:521–2.PubMedCrossRef
6.
Zurück zum Zitat Hooyman JR, Melton LJ 3rd, Nelson AM, O’Fallon WM, Riggs BL. Fractures after rheumatoid arthritis. A population-based study. Arthritis Rheum 1984;27:1353–61.PubMedCrossRef Hooyman JR, Melton LJ 3rd, Nelson AM, O’Fallon WM, Riggs BL. Fractures after rheumatoid arthritis. A population-based study. Arthritis Rheum 1984;27:1353–61.PubMedCrossRef
7.
Zurück zum Zitat Michel BA, Bloch DA, Wolfe F, Fries JF. Fractures in rheumatoid arthritis: an evaluation of associated risk factors. J Rheumatol 1993;20:1666–9.PubMed Michel BA, Bloch DA, Wolfe F, Fries JF. Fractures in rheumatoid arthritis: an evaluation of associated risk factors. J Rheumatol 1993;20:1666–9.PubMed
8.
Zurück zum Zitat Orstavik RE, Haugeberg G, Uhlig T, Mowinckel P, Falch JA, Halse JI, et al. Self reported non-vertebral fractures in rheumatoid arthritis and population based controls: incidence and relationship with bone mineral density and clinical variables. Ann Rheum Dis 2004;63:177–82.PubMedCrossRef Orstavik RE, Haugeberg G, Uhlig T, Mowinckel P, Falch JA, Halse JI, et al. Self reported non-vertebral fractures in rheumatoid arthritis and population based controls: incidence and relationship with bone mineral density and clinical variables. Ann Rheum Dis 2004;63:177–82.PubMedCrossRef
9.
Zurück zum Zitat van Staa TP, Geusens P, Bijlsma JWJ, Leufkens HGM, Cooper C. Clinical assessment of the long-term risk of fracture in patients with rheumatoid arthritis. Arthritis Rheum 2006;54:3104–12.PubMedCrossRef van Staa TP, Geusens P, Bijlsma JWJ, Leufkens HGM, Cooper C. Clinical assessment of the long-term risk of fracture in patients with rheumatoid arthritis. Arthritis Rheum 2006;54:3104–12.PubMedCrossRef
10.
Zurück zum Zitat Furuya T, Kotake S, Inoue E, Nanke Y, Yago T, Kobashigawa T, et al. Risk factors associated with incident clinical vertebral and nonvertebral fractures in Japanese women with rheumatoid arthritis: a prospective 54-month observational study. J Rheumatol 2007;34:303–10.PubMed Furuya T, Kotake S, Inoue E, Nanke Y, Yago T, Kobashigawa T, et al. Risk factors associated with incident clinical vertebral and nonvertebral fractures in Japanese women with rheumatoid arthritis: a prospective 54-month observational study. J Rheumatol 2007;34:303–10.PubMed
11.
Zurück zum Zitat Schneider R, Kaye JJ. Insufficiency and stress fractures of the long bones occurring in patients with rheumatoid arthritis. Radiology 1975;116:595–9.PubMed Schneider R, Kaye JJ. Insufficiency and stress fractures of the long bones occurring in patients with rheumatoid arthritis. Radiology 1975;116:595–9.PubMed
12.
Zurück zum Zitat Fam AG, Shuckett R, McGillivray DC, Little AH. Stress fractures in rheumatoid arthritis. J Rheumatol 1983;10:722–6.PubMed Fam AG, Shuckett R, McGillivray DC, Little AH. Stress fractures in rheumatoid arthritis. J Rheumatol 1983;10:722–6.PubMed
13.
Zurück zum Zitat West SG, Troutner JL, Baker MR, Place HM. Sacral insufficiency fractures in rheumatoid arthritis. Spine 1994;19:2117–21.PubMedCrossRef West SG, Troutner JL, Baker MR, Place HM. Sacral insufficiency fractures in rheumatoid arthritis. Spine 1994;19:2117–21.PubMedCrossRef
14.
Zurück zum Zitat Young A, Kinsella P, Boland P. Stress fractures of the lower limb in patients with rheumatoid arthritis. J Bone Joint Surg Br 1981;63:239–43.PubMed Young A, Kinsella P, Boland P. Stress fractures of the lower limb in patients with rheumatoid arthritis. J Bone Joint Surg Br 1981;63:239–43.PubMed
15.
Zurück zum Zitat Alonso-Bartolome P, Martinez-Taboada VM, Blanco R, Rodriguez-Valverde V. Insufficiency fractures of the tibia and fibula. Semin Arthritis Rheum 1999;28:413–20.PubMedCrossRef Alonso-Bartolome P, Martinez-Taboada VM, Blanco R, Rodriguez-Valverde V. Insufficiency fractures of the tibia and fibula. Semin Arthritis Rheum 1999;28:413–20.PubMedCrossRef
16.
Zurück zum Zitat Pentecost RL, Murray RA, Brindley HH. Fatigue, insufficiency, and pathologic fractures. JAMA 1964;187:1001–4.PubMed Pentecost RL, Murray RA, Brindley HH. Fatigue, insufficiency, and pathologic fractures. JAMA 1964;187:1001–4.PubMed
17.
Zurück zum Zitat Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988;31:315–24.PubMedCrossRef Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988;31:315–24.PubMedCrossRef
18.
Zurück zum Zitat Steinbrocker O, Traeger C, Batterman R. Therapeutic criteria in rheumatoid arthritis. JAMA 1949;140:659–62. Steinbrocker O, Traeger C, Batterman R. Therapeutic criteria in rheumatoid arthritis. JAMA 1949;140:659–62.
19.
Zurück zum Zitat Cooper KL, Beabout JW, Swee RG. Insufficiency fractures of the sacrum. Radiology 1985;156:15–20.PubMed Cooper KL, Beabout JW, Swee RG. Insufficiency fractures of the sacrum. Radiology 1985;156:15–20.PubMed
20.
Zurück zum Zitat Sakao K, Tokunaga D, Fujioka M, Watanabe Y, Ikoma K, Kubo T. Analysis of fractures in patients with rheumatoid arthritis (in Japanese). Kossetsu 2003;25:429–31. Sakao K, Tokunaga D, Fujioka M, Watanabe Y, Ikoma K, Kubo T. Analysis of fractures in patients with rheumatoid arthritis (in Japanese). Kossetsu 2003;25:429–31.
21.
Zurück zum Zitat Lloyd ME, Davitt S, Hall JR. Bilateral tibia and fibula fractures in a patient with rheumatoid arthritis. Clin Rheumatol 2001;20:270–2.PubMedCrossRef Lloyd ME, Davitt S, Hall JR. Bilateral tibia and fibula fractures in a patient with rheumatoid arthritis. Clin Rheumatol 2001;20:270–2.PubMedCrossRef
22.
Zurück zum Zitat Vanhoof J, Landewe S, Vandevenne J, Geusens P. An exceptional radiographic presentation of bilateral insufficiency fractures of the proximal tibia in a patient with rheumatoid arthritis. Ann Rheum Dis 2003;62:277–9.PubMedCrossRef Vanhoof J, Landewe S, Vandevenne J, Geusens P. An exceptional radiographic presentation of bilateral insufficiency fractures of the proximal tibia in a patient with rheumatoid arthritis. Ann Rheum Dis 2003;62:277–9.PubMedCrossRef
23.
Zurück zum Zitat Wild A, Jaeger M, Haak H, Mehdian SH. Sacral insufficiency fracture, an unsuspected cause of low-back pain in elderly women. Arch Orthop Trauma Surg 2002;122:58–60.PubMed Wild A, Jaeger M, Haak H, Mehdian SH. Sacral insufficiency fracture, an unsuspected cause of low-back pain in elderly women. Arch Orthop Trauma Surg 2002;122:58–60.PubMed
24.
Zurück zum Zitat Peh WC, Gough AK, Sheeran T, Evans NS, Emery P. Pelvic insufficiency fractures in rheumatoid arthritis. Br J Rheumatol 1993;32:319–24.PubMedCrossRef Peh WC, Gough AK, Sheeran T, Evans NS, Emery P. Pelvic insufficiency fractures in rheumatoid arthritis. Br J Rheumatol 1993;32:319–24.PubMedCrossRef
25.
Zurück zum Zitat Godfrey N, Staple TW, Halter D, Lorber A. Insufficiency os pubis fractures in rheumatoid arthritis. J Rheumatol 1985;12:1176–9.PubMed Godfrey N, Staple TW, Halter D, Lorber A. Insufficiency os pubis fractures in rheumatoid arthritis. J Rheumatol 1985;12:1176–9.PubMed
26.
Zurück zum Zitat Soubrier M, Dubost JJ, Boisgard S, Sauvezie B, Gaillard P, Michel JL, et al. Insufficiency fracture. A survey of 60 cases and review of the literature. Joint Bone Spine 2003;70:209–18.PubMedCrossRef Soubrier M, Dubost JJ, Boisgard S, Sauvezie B, Gaillard P, Michel JL, et al. Insufficiency fracture. A survey of 60 cases and review of the literature. Joint Bone Spine 2003;70:209–18.PubMedCrossRef
27.
28.
Zurück zum Zitat Ries T. Detection of osteoporotic sacral fractures with radionuclides. Radiology 1983;146:783–5.PubMed Ries T. Detection of osteoporotic sacral fractures with radionuclides. Radiology 1983;146:783–5.PubMed
29.
Zurück zum Zitat Orstavik RE, Haugeberg G, Uhlig T, Falch JA, Halse JI, Hoiseth A, et al. Vertebral deformities in 229 female patients with rheumatoid arthritis: associations with clinical variables and bone mineral density. Arthritis Rheum 2003;49:355–60.PubMedCrossRef Orstavik RE, Haugeberg G, Uhlig T, Falch JA, Halse JI, Hoiseth A, et al. Vertebral deformities in 229 female patients with rheumatoid arthritis: associations with clinical variables and bone mineral density. Arthritis Rheum 2003;49:355–60.PubMedCrossRef
30.
Zurück zum Zitat Maenpaa HM, Soini I, Lehto MU, Belt EA. Insufficiency fractures in patients with chronic inflammatory joint diseases. Clin Exp Rheumatol 2002;20:77–9.PubMed Maenpaa HM, Soini I, Lehto MU, Belt EA. Insufficiency fractures in patients with chronic inflammatory joint diseases. Clin Exp Rheumatol 2002;20:77–9.PubMed
31.
Zurück zum Zitat Ma J, Markides KS, Perkowski LP, Stroup-Benham CA, Lichtenstein M, Goodwin JS. Impact of selected medical conditions on self-reported lower-extremity function in Mexican-American elderly. Ethn Dis 1998;8:52–9.PubMed Ma J, Markides KS, Perkowski LP, Stroup-Benham CA, Lichtenstein M, Goodwin JS. Impact of selected medical conditions on self-reported lower-extremity function in Mexican-American elderly. Ethn Dis 1998;8:52–9.PubMed
32.
Zurück zum Zitat Stel VS, Pluijm SM, Deeg DJ, Smit JH, Bouter LM, Lips P. Functional limitations and poor physical performance as independent risk factors for self-reported fractures in older persons. Osteoporos Int 2004;15:742–50.PubMedCrossRef Stel VS, Pluijm SM, Deeg DJ, Smit JH, Bouter LM, Lips P. Functional limitations and poor physical performance as independent risk factors for self-reported fractures in older persons. Osteoporos Int 2004;15:742–50.PubMedCrossRef
33.
Zurück zum Zitat Colon-Emeric CS, Pieper CF, Artz MB. Can historical and functional risk factors be used to predict fractures in community-dwelling older adults? Development and validation of a clinical tool. Osteoporos Int 2002;13:955–61.PubMedCrossRef Colon-Emeric CS, Pieper CF, Artz MB. Can historical and functional risk factors be used to predict fractures in community-dwelling older adults? Development and validation of a clinical tool. Osteoporos Int 2002;13:955–61.PubMedCrossRef
34.
Zurück zum Zitat Kleerekoper M, Nelson DA. Vertebral fracture or vertebral deformity. Calcif Tissue Int 1992;50:5–6.PubMedCrossRef Kleerekoper M, Nelson DA. Vertebral fracture or vertebral deformity. Calcif Tissue Int 1992;50:5–6.PubMedCrossRef
35.
Zurück zum Zitat Cooper C, Atkinson EJ, O’Fallon WM, Melton LJ 3rd. Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985–1989. J Bone Miner Res 1992;7:221–7.PubMedCrossRef Cooper C, Atkinson EJ, O’Fallon WM, Melton LJ 3rd. Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985–1989. J Bone Miner Res 1992;7:221–7.PubMedCrossRef
36.
Zurück zum Zitat Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 1996;348:1535–41.PubMedCrossRef Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 1996;348:1535–41.PubMedCrossRef
37.
Zurück zum Zitat Ross PD. Clinical consequences of vertebral fractures. Am J Med 1997;103:30S–42S (discussion 42S–3S).PubMedCrossRef Ross PD. Clinical consequences of vertebral fractures. Am J Med 1997;103:30S–42S (discussion 42S–3S).PubMedCrossRef
38.
Zurück zum Zitat Arai K, Hanyu T, Sugitani H, Murai T, Fujisawa J, Nakazono K, et al. Risk factors for vertebral fracture in menopausal or postmenopausal Japanese women with rheumatoid arthritis: a cross-sectional and longitudinal study. J Bone Miner Metab 2006;24:118–24.PubMedCrossRef Arai K, Hanyu T, Sugitani H, Murai T, Fujisawa J, Nakazono K, et al. Risk factors for vertebral fracture in menopausal or postmenopausal Japanese women with rheumatoid arthritis: a cross-sectional and longitudinal study. J Bone Miner Metab 2006;24:118–24.PubMedCrossRef
Metadaten
Titel
Characteristics of fracture and related factors in patients with rheumatoid arthritis
verfasst von
Akihide Nampei
Jun Hashimoto
Junichiro Koyanagi
Takeshi Ono
Hideo Hashimoto
Noriyuki Tsumaki
Tetsuya Tomita
Kazuomi Sugamoto
Norihiro Nishimoto
Takahiro Ochi
Hideki Yoshikawa
Publikationsdatum
01.04.2008
Verlag
Springer Japan
Erschienen in
Modern Rheumatology / Ausgabe 2/2008
Print ISSN: 1439-7595
Elektronische ISSN: 1439-7609
DOI
https://doi.org/10.1007/s10165-008-0032-5

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