Men and women with rheumatoid arthritis (RA) are at risk for bone fractures, with comparable risks for fractures specific to the vertebral and hip, according to results from a recent meta-analysis by A-Li Xue, BS, Department of Hematology, The Third Affiliated Hospital of Wenzhou Medical University (Ruian People’s Hospital), Zhejiang, China, and colleagues (Xue AL, et al. Medicine(Baltimore). 2017;96:e6983).
“Over the years, numerous observational studies have associated patients with RA with the increased risk of osteoporosis fracture involving mainly the hip or vertebral. However, most clinical studies performed are either limited in sample size, restricted to a certain subpopulation, or are fracture-site specific. The risk of bone fracture in RA patients has not been summarized and little is known whether the risk of fracture is site-specific,” Mr Xue and colleagues explained.
To determine the relationship between RA and bone fracture risk, particularly with regard to sex and site-specific fractures, the investigators conducted a meta-analysis of 13 studies related to bone fractures in patients with RA. These studies were conducted in a variety of countries, including the United States, United Kingdom, Sweden, Norway, Finland, Australia, and China, and gleaned from databases such as PubMed, EMBASE, and OVID.
The quality of the studies was assessed using the Newcastle-Ottawa Scale, and results of the meta-analysis were reported using a random-effects model.
In their meta-analysis, Mr Xue and colleagues observed a significantly higher risk for bone fracture among patients with RA compared with those without the disease (risk ratio [RR] = 2.25; 95% confidence interval [CI], 1.76-2.87). They also found that, per subgroup analyses, patients of both sexes with RA were at a similar increased risk for bone fracture compared with men and women without RA (women: RR = 1.99; 95% CI, 1.58-2.50; men: RR = 1.87; 95% CI, 1.48-2.37). In the subgroup analysis of site-specific fracture risk, it was demonstrated that RA positively correlated with the occurrence of hip (RR = 2.41; 95% CI, 1.83-3.17) or vertebral (RR = 2.93; 95% CI, 2.25-3.83) fractures, leading the investigators to suggest that there is no specificity in the site fracture.
“Our results show a similar increased risk of fracture in men and women with RA than those without RA, further suggesting that RA is an independent risk factor for fracture....As fracture often reduces quality of life, fracture prevention is, therefore, crucial for patients with RA,” Mr Xue and colleagues said, adding that patients with RA should be monitored closely to control loss of bone and prevent fractures.