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

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, Sang Cheol Bae

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33 Scopus citations


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.

Original languageEnglish
Pages (from-to)1205-1214
Number of pages10
JournalRheumatology International
Issue number9
StatePublished - 1 Sep 2016

Bibliographical note

Publisher Copyright:
© 2016, Springer-Verlag Berlin Heidelberg.


  • Cohort studies
  • Fractures
  • Incidence
  • Rheumatoid arthritis
  • Risk factors


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