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Open Access Research article

Rheumatoid arthritis and incident fracture in women: a case–control study

Sharon L Brennan123*, Liesje Toomey1, Mark A Kotowicz12, Margaret J Henry1, Hedley Griffiths4 and Julie A Pasco12

Author Affiliations

1 School of Medicine, Deakin University, Geelong, Victoria, Australia

2 NorthWest Academic Centre, The University of Melbourne, St Albans, Victoria, Australia

3 Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne, St Albans, Victoria, Australia

4 Barwon Rheumatology Service, Geelong, Victoria, Australia

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BMC Musculoskeletal Disorders 2014, 15:13  doi:10.1186/1471-2474-15-13

Published: 9 January 2014

Abstract

Background

To examine fracture incidence in women with rheumatoid arthritis (RA) for an entire geographical region of south-eastern Australia.

Methods

Women aged 35 years and older, resident in the Barwon Statistical Division (BSD) and clinically diagnosed with RA 1994–2001 were eligible for inclusion as cases (n = 1,008). The control population (n = 172,422) comprised the entire female BSD population aged 35 years and older, excluding those individuals identified as cases. Incident fractures were extracted from the prospective Geelong Osteoporosis Study Fracture Grid. We calculated rate ratios (RR) and 95% confidence intervals (CI) to compare the age-adjusted rate of fracture between the RA and non-RA populations, and used a chi-square test to compare proportions of fractures between women with and without RA, and a two-sided Mann–Whitney U-test to examine age-differences.

Results

Among 1,008 women with RA, 19 (1.9%) sustained a fracture, compared to 1,981 fractures sustained by the 172,422 women without RA (1.2%). Fracture rates showed a trend for being greater among women diagnosed with RA (age-adjusted RR 1.43, 95%CI 0.98-2.09, p = 0.08). Women with RA sustained vertebral fractures at twice the expected frequency, whereas hip fractures were underrepresented in the RA population (p < 0.001). RA status was not associated with the likelihood of sustaining a fracture at sites adjacent to joints most commonly affected by RA (p = 0.22).

Conclusion

Given that women with RA have a greater risk of fracture compared to women without RA, these patients may be a suitable target population for anti-resorptive agents; however, larger studies are warranted.

Keywords:
Incident fracture; Rheumatoid arthritis; Epidemiology; Women