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Sites, frequencies, and causes of self-reported fractures in 9,720 rheumatoid arthritis patients: a large prospective observational cohort study in Japan

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Abstract

Summary

Sites, frequencies, and causes of self-reported fractures in Japanese patients with rheumatoid arthritis (RA) were evaluated in a prospective, observational cohort study. The incidence and cause of fracture differ by anatomical site, sex, and age. These differences may be considered in establishing custom strategies for preventing fractures in RA patients in the future.

Purpose

The literature contains limited data describing the details of fractures at different skeletal sites in patients with RA.

Methods

We evaluated the details of fractures in Japanese RA patients on the basis of our Institute of Rheumatology Rheumatoid Arthritis cohort study in 9,720 RA patients (82 % women; mean age, 56 years) who were enrolled from 2000 to 2010. The details of fractures were obtained through biannual patient self-report questionnaires.

Results

Over a mean duration of 5.2 years, 1,317 patients (13.5 %) reported 2,323 incident fractures comprising 563 (24.2 %) clinical vertebral fractures and 1,760 (75.8 %) nonvertebral fractures. Rib fractures were the most common fractures in men, followed by clinical vertebral and hip fractures; the most common fractures in women were clinical vertebral fractures, followed by rib, foot, and hip fractures. There was a significant difference between sexes in the rates of rib, clavicle, shoulder, and ankle fractures. Spontaneous event was the primary cause of clinical vertebral fracture (65.4 %), whereas falls were the primary cause of upper extremity (76.5 %) and lower extremity (57.8 %) fractures. Rates of clinical vertebral and hip fractures increased, while those of rib and foot fractures decreased with increasing age. Incidence of falls, as causes of nonvertebral fractures, also increased in older age groups.

Conclusion

Our results suggest that the causes of fractures may differ depending on anatomical site and that prevention of falls may be the most effective way to reduce upper and lower extremity fractures, especially in older patients with RA.

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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 to Professor Y. Toyama and other members of the Department of Orthopedic Surgery, Keio University School of Medicine, for their support. This work was supported in part by grants-in-aid for scientific research from the Japan Society for the Promotion of Science to KO and from the Japan Osteoporosis Society to TF. The IORRA cohort was supported by non-restricted research grants from 40 pharmaceutical companies: Abbott Japan Co. Ltd., Asahikasei Kuraray Medical Co. Ltd., Asahikasei Pharma Corporation, Astellas Pharma Inc., AstraZeneca K.K., Bristol-Myers Squibb, Chugai Pharmaceutical Co. Ltd., Daiichi Fine Chemical Co. Ltd., Daiichi Sankyo Co. Ltd., Dainippon Sumitomo Pharma Co. Ltd., Dentsu, Sudler & Hennessey Inc., Eisai Co. Ltd. , GlaxoSmithKline K.K. , Hisamitsu Pharmaceutical Co. Inc., Janssen Pharmaceutical K.K. Japan, Tobacco Inc., Kaken Pharmaceutical Co. Ltd., Kissei Pharmaceutical Co. Ltd., Kowa Pharmaceutical Co. Ltd., Maruho Co. Ltd., Mitsubishi Chemical Medience Corporation, Mitsubishi Tanabe Pharma Corporation, Mochida Pharmaceutical Co. Ltd., MSD K.K., Mundipharma K.K., Nippon Chemiphar Co. Ltd., Nippon Shinyaku Co. Ltd., Novartis Pharma K.K., Otsuka Pharmaceutical Co. Ltd., Pfizer Japan Inc., Sanofi-Aventis K.K., Santen Pharmaceutical Co. Ltd., Sanwa Kagaku Kenkyusho Co. Ltd., Sekisui Medical Co. Ltd., Shionogi Co. Ltd., Taishotoyama Pharmaceutical Co. Ltd, Takeda Pharmaceutical Company Limited, Teijin Pharma Limited, Torii Pharmaceutical Co. Ltd., UCB Japan Co. Ltd., and ZERIA Pharmaceutical Co. Ltd.

Conflicts of interest

HY has received consulting and/or speaking fee from: Abbott Japan Co. Ltd., AstraZeneca K.K., Bristol-Myers Squibb, Chugai Pharmaceutical Co. Ltd., Eisai Co. Ltd., Janssen Pharmaceutical K.K. Japan, Mitsubishi Tanabe Pharma Corporation, Pfizer Japan Inc., Takeda Pharmaceutical Co. Ltd., Teijin Pharma Limited, and UCB Japan Co. Ltd. The rest of the authors have no conflict of interest to state.

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Authors and Affiliations

  1. Institute of Rheumatology, Tokyo Women’s Medical University, 10-22 Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan

    Kensuke Ochi, Takefumi Furuya, Katsunori Ikari, Atsuo Taniguchi, Hisashi Yamanaka & Shigeki Momohara

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  1. Kensuke Ochi
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  2. Takefumi Furuya
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  3. Katsunori Ikari
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  6. Shigeki Momohara
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Correspondence to Takefumi Furuya.

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Ochi, K., Furuya, T., Ikari, K. et al. 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 (2013). https://doi.org/10.1007/s11657-013-0130-7

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