Abstract
The aims of this study were to evaluate the association between potential risk factors and the occurrence of distal radius fractures in Japanese patients with rheumatoid arthritis (RA). A total of 9,987 patients (82.0 % female; mean age, 55.7 years) with RA were enrolled in a prospective, observational study from 2000 to 2011. Self-reported distal radius fractures were verified using patient medical records. Cox proportional hazards models were used to analyze independent contributions of various risk factors to distal radius fracture occurrence. During a mean follow-up of 5.7 years, 139 patients reported 153 distal radius fractures. Among these patients, 85 distal radius fractures following minor trauma in 85 patients (6 men, 79 women) were verified with medical records. Female gender (hazard ratio [HR], 2.96; 95 % confidence interval [CI], 1.18–7.45; P = 0.021), age (per 10 years, HR 1.55; 95 % CI, 1.24–1.95, P = 0.00016), body mass index (BMI) (per 1 kg/m2, HR, 1.11; 95 % CI, 1.03–1.19; P = 0.0034), daily prednisolone dose (per milligram per day, HR, 1.10; 95 % CI, 1.05–1.16; P = 0.00015), and physician global visual analog scale (0–10 cm, HR, 0.98; 95 % CI, 0.96–1.00; P = 0.034) were significantly associated with the occurrence of distal radius fractures in Japanese patients with RA. A reduction in the daily prednisolone dose, together with the prevention of falls in female patients of advanced age with RA and a high BMI may be important in preventing distal radius fractures.
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References
Cooper C, Coupland C, Mitchell M (1995) Rheumatoid arthritis, corticosteroid therapy and hip fracture. Ann Rheum Dis 54:49–52
Hooyman JR, Melton LJ 3rd, Nelson AM, O'Fallon WM, Riggs BL (1984) Fractures after rheumatoid arthritis. A population-based study. Arthrit Rheum 27:1353–1361
Kim SY, Schneeweiss S, Liu J, Daniel GW, Chang CL, Garneau K, Solomon DH (2010) Risk of osteoporotic fracture in a large population-based cohort of patients with rheumatoid arthritis. Arthritis Res Ther 12:R154
Orstavik RE, Haugeberg G, Uhlig T, Mowinckel P, Falch JA, Halse JI, Kvien TK (2004) 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 63:177–182
van Staa TP, Geusens P, Bijlsma JW, Leufkens HG, Cooper C (2006) Clinical assessment of the long-term risk of fracture in patients with rheumatoid arthritis. Arthritis Rheum 54:3104–3112
Wright NC, Lisse JR, Walitt BT, Eaton CB, Chen Z (2011) Arthritis increases the risk for fractures—results from the Women's Health Initiative. J Rheumatol 38:1680–1688
Papaioannou A, Joseph L, Ioannidis G, Berger C, Anastassiades T, Brown JP, Hanley DA, Hopman W, Josse RG, Kirkland S, Murray TM, Olszynski WP, Pickard L, Prior JC, Siminoski K, Adachi JD (2005) Risk factors associated with incident clinical vertebral and nonvertebral fractures in postmenopausal women: the Canadian Multicentre Osteoporosis Study (CaMos). Osteoporos Int 16:568–578
Ochi K, Furuya T, Ikari K, Taniguchi A, Yamanaka H, Momohara S (2013) Sites, frequencies, and causes of self-reported fractures in 9,720 rheumatoid arthritis patients: a large prospective observational cohort study in Japan. Arch Osteoporos 8:130
Kelsey JL, Browner WS, Seeley DG, Nevitt MC, Cummings SR (1992) Risk factors for fractures of the distal forearm and proximal humerus. The Study of Osteoporotic Fractures Research Group. Am J Epidemiol 135:477–489
van Staa TP, Dennison EM, Leufkens HG, Cooper C (2001) Epidemiology of fractures in England and Wales. Bone 29:517–522
Kelsey JL, Prill MM, Keegan TH, Tanner HE, Bernstein AL, Quesenberry CP Jr, Sidney S (2005) Reducing the risk for distal forearm fracture: preserve bone mass, slow down, and don't fall! Osteoporos Int 16:681–690
Vogt MT, Cauley JA, Tomaino MM, Stone K, Williams JR, Herndon JH (2002) Distal radius fractures in older women: a 10-year follow-up study of descriptive characteristics and risk factors. The study of osteoporotic fractures. J Am Geriatr Soc 50:97–103
Harness NG, Funahashi T, Dell R, Adams AL, Burchette R, Chen X, Greene D (2012) Distal radius fracture risk reduction with a comprehensive osteoporosis management program. J Hand Surg [Am] 37:1543–1549
O'Neill TW, Cooper C, Finn JD, Lunt M, Purdie D, Reid DM, Rowe R, Woolf AD, Wallace WA (2001) Incidence of distal forearm fracture in British men and women. Osteoporos Int 12:555–558
Graafmans WC, Ooms ME, Bezemer PD, Bouter LM, Lips P (1996) Different risk profiles for hip fractures and distal forearm fractures: a prospective study. Osteoporos Int 6:427–431
Honkanen R, Tuppurainen M, Kroger H, Alhava E, Puntila E (1997) Associations of early premenopausal fractures with subsequent fractures vary by sites and mechanisms of fractures. Calcif Tissue Int 60:327–331
Oyen J, Brudvik C, Gjesdal CG, Tell GS, Lie SA, Hove LM (2011) Osteoporosis as a risk factor for distal radial fractures: a case–control study. J Bone Joint Surg Am 93:348–356
Mallmin H, Ljunghall S, Persson I, Bergstrom R (1994) Risk factors for fractures of the distal forearm: a population-based case–control study. Osteoporos Int 4:298–304
Rikkonen T, Salovaara K, Sirola J, Karkkainen M, Tuppurainen M, Jurvelin J, Honkanen R, Alhava E, Kroger H (2010) Physical activity slows femoral bone loss but promotes wrist fractures in postmenopausal women: a 15-year follow-up of the OSTPRE study. J Bone Miner Res 25:2332–2340
Hagino H, Fujiwara S, Nakashima E, Nanjo Y, Teshima R (2004) Case–control study of risk factors for fractures of the distal radius and proximal humerus among the Japanese population. Osteoporos Int 15:226–230
Sakai A, Oshige T, Zenke Y, Yamanaka Y, Otsuka H, Nakamura T (2010) Shorter unipedal standing time and lower bone mineral density in women with distal radius fractures. Osteoporos Int 21:733–739
Furuya T, Kotake S, Inoue E, Nanke Y, Yago T, Hara M, Tomatsu T, Kamatani N, Yamanaka H (2008) Risk factors associated with incident fractures in Japanese men with rheumatoid arthritis: a prospective observational cohort study. J Bone Miner Metab 26:499–505
Furuya T, Kotake S, Inoue E, Nanke Y, Yago T, Kobashigawa T, Ichikawa N, Tanaka E, Momohara S, Nakajima A, Hara M, Tomatsu T, Yamanaka H, Kamatani N (2007) Risk factors associated with incident clinical vertebral and nonvertebral fractures in Japanese women with rheumatoid arthritis: a prospective 54-month observational study. J Rheumatol 34:303–310
Furuya T, Inoue E, Hosoi T, Taniguchi A, Momohara S, Yamanaka H (2013) Risk factors associated with the occurrence of hip fracture in Japanese patients with rheumatoid arthritis: a prospective observational cohort study. Osteoporos Int 24:1257–1265
Furuya T, Yamagiwa K, Ikai T, Inoue E, Taniguchi A, Momohara S, Yamanaka H (2009) Associated factors for falls and fear of falling in Japanese patients with rheumatoid arthritis. Clin Rheumatol 28:1325–1330
Yamanaka H, Seto Y, Tanaka E, Furuya T, Nakajima A, Ikari K, Taniguchi A, Momohara S (2012) Management of rheumatoid arthritis: the 2012 perspective. Mod Rheumatol 23:1–7
Prevoo ML, van't Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL (1995) Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 38:44–48
Matsuda Y, Singh G, Yamanaka H, Tanaka E, Urano W, Taniguchi A, Saito T, Hara M, Tomatsu T, Kamatani N (2003) Validation of a Japanese version of the Stanford Health Assessment Questionnaire in 3,763 patients with rheumatoid arthritis. Arthritis Rheum 49:784–788
Muraki S, Akune T, Ishimoto Y, Nagata K, Yoshida M, Tanaka S, Oka H, Kawaguchi H, Nakamura K, Yoshimura N (2013) Risk factors for falls in a longitudinal population-based cohort study of Japanese men and women: the ROAD Study. Bone 52:516–523
Roy DK, Pye SR, Lunt M, O'Neill TW, Todd C, Raspe H, Reeve J, Silman AJ, Weber K, Dequeker J, Jajic I, Stepan J, Delmas PD, Marchand F, Reisinger W, Banzer D, Felsenberg D, Janott J, Kragl G, Schiedt-Nave C, Felsch B, Raspe H, Matthis C, Lyritis G, Poor G, Gennari C, Pols HA, Falch JA, Miazgowski T, Hoszowski K, Lorenc R, Bruges Armas J, Lopes Vaz A, Benevolenskaya LI, Masaryk P, Rapado A, Cannata JB, Naves-Diaz M, Johnell O, Dilsen G, Reid DM, Bhalla AK, Todd C, Reeve J, Finn JD, Ismail A, Lunt M, O'Neill TW, Pye SR, Roy DK, Kanis JA, Cooper C, Woolf AD (2002) Falls explain between-center differences in the incidence of limb fracture across Europe. Bone 31:712–717
van der Helm-van Mil AH, van der Kooij SM, Allaart CF, Toes RE, Huizinga TW (2008) A high body mass index has a protective effect on the amount of joint destruction in small joints in early rheumatoid arthritis. Ann Rheum Dis 67:769–774
Stavropoulos-Kalinoglou A, Metsios GS, Panoulas VF, Nevill AM, Jamurtas AZ, Koutedakis Y, Kitas GD (2009) Underweight and obese states both associate with worse disease activity and physical function in patients with established rheumatoid arthritis. Clin Rheumatol 28:439–444
Hagino H, Yamamoto K, Teshima R, Kishimoto H, Nakamura T (1990) Fracture incidence and bone mineral density of the distal radius in Japanese children. Arch Orthop Trauma Surg 109:262–264
Hagino H, Yamamoto K, Ohshiro H, Nakamura T, Kishimoto H, Nose T (1999) Changing incidence of hip, distal radius, and proximal humerus fractures in Tottori Prefecture, Japan. Bone 24:265–270
Nevitt MC, Cummings SR, Browner WS, Seeley DG, Cauley JA, Vogt TM, Black DM (1992) The accuracy of self-report of fractures in elderly women: evidence from a prospective study. Am J Epidemiol 135:490–499
Nevitt MC, Cummings SR (1993) Type of fall and risk of hip and wrist fractures: the study of osteoporotic fractures. The Study of Osteoporotic Fractures Research Group. J Am Geriatr Soc 41:1226–1234
Ismail AA, O'Neill TW, Cockerill W, Finn JD, Cannata JB, Hoszowski K, Johnell O, Matthis C, Raspe H, Raspe A, Reeve J, Silman AJ (2000) Validity of self-report of fractures: results from a prospective study in men and women across Europe. EPOS Study Group. European Prospective Osteoporosis Study Group. Osteoporos Int 11:248–254
Chen Z, Kooperberg C, Pettinger MB, Bassford T, Cauley JA, LaCroix AZ, Lewis CE, Kipersztok S, Borne C, Jackson RD (2004) Validity of self-report for fractures among a multiethnic cohort of postmenopausal women: results from the Women's Health Initiative observational study and clinical trials. Menopause 11:264–274
Nakamura K, Inoue M, Kaneko Y, Tsugane S (2011) Positive predictive values for self-reported fractures in an adult Japanese population. Environ Health Prev Med 16:129–132
Acknowledgments
We thank Dr. Eisuke Inoue and all members of the Institute of Rheumatology, Tokyo Women's Medical University for the successful management of the IORRA cohort. We also thank Prof. Y. Toyama and other members of the Department of Orthopedic Surgery, Keio University School of Medicine for their support.
Funding sources
This work was supported in part by grants-in-aid for scientific research from the Japan Society for the Promotion of Science to KO, by the Nakatomi Foundation and the Japan Orthopaedics and Traumatology Foundation to KO, and from the Japan Osteoporosis Society to TF. The IORRA cohort was supported by non-restricted research grants from 34 pharmaceutical companies: AbbVie GK, Asahikasei Pharma Corporation, Astellas Pharma Inc., Bristol-Myers Squibb, Chugai Pharmaceutical Co., Ltd., Daiichi Fine Chemical Co., Ltd., Daiichi Sankyo Co., Ltd., Dainippon Sumitomo Pharma Co., Ltd., Eisai Co., Ltd., GlaxoSmithKline K.K., Hisamitsu Pharmaceutical Co., Inc., Japan Tobacco Inc., Kaken Pharmaceutical Co., Ltd., Kissei Pharmaceutical Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Maruho Co., Ltd., Mitsubishi Tanabe Pharma Corporation, MSD K.K., Nippon Chemiphar Co., Ltd., Nippon Katyaku Co., Ltd., Nippon Shinyaku Co., Ltd., Novartis Pharma K.K., Ono Pharmaceutical Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Pfizer Japan Inc., Santen Pharmaceutical Co., Ltd., Sekisui Medical Co., Ltd., Shionogi Co., Ltd., Taishotoyama Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co. Ltd., Teijin Pharma Limited, Torii Pharmaceutical Co., Ltd., UCB Japan Co. Ltd., ZERIA Pharmaceutical Co., Ltd.
Conflict of interest
HY has received research grants from: Abbott, AbbVie, Asahikasei, Astellas, AstraZeneca, Bristol-Myers Squibb, Chugai, Daiichi Sankyo, Eisai, GlaxoSmithKline, Janssen, Mitsubishi Tanabe, MSD, Nippon Kayaku, Pfizer, Santen, Taishotoyama, Takeda, and Teijin, consulting fees from: Abbott, AbbVie, Astellas, AstraZeneca, Bristol-Myers Squibb, Chugai, Daiichi Sankyo, Eisai, Mitsubishi Tanabe, Nippon Kayaku, Pfizer, Takeda, and Teijin, and is a member of the Speakers bureaus of: Abbott, AbbVie, Astellas, Bristol-Myers Squibb, Chugai, Eisai, Mitsubishi Tanabe, Pfizer, Takeda, and Teijin. The remaining authors have no conflicts of interest to state.
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Ochi, K., Go, Y., Furuya, T. et al. Risk factors associated with the occurrence of distal radius fractures in Japanese patients with rheumatoid arthritis: a prospective observational cohort study. Clin Rheumatol 33, 477–483 (2014). https://doi.org/10.1007/s10067-013-2415-z
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DOI: https://doi.org/10.1007/s10067-013-2415-z