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Incidence and risk factors of fractures in patients with rheumatoid arthritis: an Asian prospective cohort study

  • Epidemiology of RMD
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Rheumatoid arthritis (RA) patients have high risk for osteoporosis and fracture. We aimed to identify the incidence rate and risk factors of fractures in Asian RA patients. A total of 3557 RA patients in the KORean Observational study Network for Arthritis (KORONA) were included and observed over a mean follow-up of 18 months. A fracture was assessed as total, major, or minor fractures; major fracture was defined as a vertebral or hip fracture, and the other fractures were classified as minor fractures. The standardized incidence ratio (SIR) of fracture in RA patients was calculated compared with general population, and possible risk factors for fractures were explored using multivariable logistic regression analyses. A total of 194 patients with 215 fractures were observed, and the SIR of the total fracture in RA patients was 2.2 [95 % confidence interval (CI) 1.9–2.6]. The SIRs of major and minor fractures were 1.5 (CI 1.1–2.0) and 3.0 (CI 2.5–3.7), respectively. Advanced age [odds ratio (OR) 1.03, CI 1.02–1.05, p < 0.01] and having history of prior fracture (OR 2.17, CI 1.54–3.08, p < 0.01) were risk factors for total fractures. In addition, higher HAQ increased fracture risk (OR 2.02, CI 1.05–3.89, p = 0.04), whereas the use of bisphosphonate showed protective effect for future fractures (OR 0.34, CI 0.14–0.87, p = 0.02) in patients with osteoporosis. RA patients had a 2.2-fold increased risk of fractures as compared with general population. In Asian RA patients, advanced age and history of prior fracture were the most important risk factors for new fractures.

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The authors wish to acknowledge the assistance of the following investigators who have enrolled patients to KORONA: Drs. Joong Kyong Ahn, So-Young Bang, Hoon-Suk Cha, Jung-Yoon Choe, Sung Jae Choi, Won Tae Chung, Minyoung Her, Seung-Jae Hong, Chung-Il Joung, Young Ok Jung, Young Mo Kang, Dong-Yook Kim, Hae-Rim Kim, Hyoun Ah Kim, Jinseok Kim, Seong-Kyu Kim, Tae-Jong Kim, Eunmi Koh, Choong Ki Lee, Jaejoon Lee, Sang-Heon Lee, Sang-Hoon Lee, Sung Won Lee, Seong-Su Nah, Sung-Hoon Park, Dong Hyuk Sheen, Seung-Cheol Shim, Gwan Gyu Song, Chang-Hee Suh, Soyoung Won, Bo Young Yoon.


This study was supported by a grant of the Korea Healthcare technology R&D Project, Ministry of Health and Welfare, Republic of Korea (HI10C2020).

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Correspondence to Yoon-Kyoung Sung or Sang-Cheol Bae.

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Dam Kim, Soo-Kyung Cho, Chan-Bum Choi, Jae-Bum Jun, Tae-Hwan Kim, Hye-Soon Lee, Jisoo Lee, Shin-Seok Lee, Dae-Hyun Yoo, Wan-Hee Yoo, Yoon-Kyoung Sung, and Sang-Cheol Bae declare that they have no conflict of interests.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Yoon-Kyoung Sung and Sang-Cheol Bae contributed equally to this work and are joint corresponding authors.

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Kim, D., Cho, SK., Choi, CB. et al. Incidence and risk factors of fractures in patients with rheumatoid arthritis: an Asian prospective cohort study. Rheumatol Int 36, 1205–1214 (2016).

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