Abstract：
OBJECTIVE: To examine the risk of fractures in a cohort of patients with newly diagnosed rheumatoid arthritis (RA), compared to the background population, and predictors of fractures detectable early in RA.
METHODS: An inception cohort of patients with RA (N = 233; 164 women/69 men, recruited 1995-2005) was evaluated according to a structured program, including repeated clinical assessments and measures of bone mineral density (BMD), from diagnosis to 10 years later. Matched population controls were identified using the national census register. Fractures through 2019 were identified based on ICD codes. Cox regression models were used to assess the risk of fractures in RA patients compared with controls, and for assessment of potential predictors for fractures in the RA population.
RESULTS: RA patients had an increased risk of fractures (fully adjusted hazard ratio (HR) 1.52, 95 % CI 1.13; 2.06). In the RA cohort, high age, low body mass index, and low BMD were significant baseline predictors of future fractures in multivariate analyses, but baseline RA disease characteristics were not. Worse disability (i.e. higher Health Assessment Questionnaire (HAQ) scores) over time was significantly associated with increased risk of fractures (age-sex-adjusted HR 1.33 per SD, 95 % CI 1.09; 1.63) and there was an inverse association between BMD Z-scores over time and fractures.
CONCLUSIONS: Patients with RA had higher risk of fractures than controls. Fracture risk was related to BMD at baseline and over time in patients with RA. In addition, worse disability (measured by HAQ) over time was associated with higher risk of fractures.
METHODS: An inception cohort of patients with RA (N = 233; 164 women/69 men, recruited 1995-2005) was evaluated according to a structured program, including repeated clinical assessments and measures of bone mineral density (BMD), from diagnosis to 10 years later. Matched population controls were identified using the national census register. Fractures through 2019 were identified based on ICD codes. Cox regression models were used to assess the risk of fractures in RA patients compared with controls, and for assessment of potential predictors for fractures in the RA population.
RESULTS: RA patients had an increased risk of fractures (fully adjusted hazard ratio (HR) 1.52, 95 % CI 1.13; 2.06). In the RA cohort, high age, low body mass index, and low BMD were significant baseline predictors of future fractures in multivariate analyses, but baseline RA disease characteristics were not. Worse disability (i.e. higher Health Assessment Questionnaire (HAQ) scores) over time was significantly associated with increased risk of fractures (age-sex-adjusted HR 1.33 per SD, 95 % CI 1.09; 1.63) and there was an inverse association between BMD Z-scores over time and fractures.
CONCLUSIONS: Patients with RA had higher risk of fractures than controls. Fracture risk was related to BMD at baseline and over time in patients with RA. In addition, worse disability (measured by HAQ) over time was associated with higher risk of fractures.
摘要：
目的：为了检查新诊断的类风湿性关节炎（RA）患者的骨折风险，与背景人口相比，以及RA早期可检测骨折的预测因子。
方法：RA患者的初始队列（N=233；164名女性/69名男性，1995-2005年招募)根据结构化计划进行评估，包括重复的临床评估和骨矿物质密度（BMD）的测量，从诊断到10年后。使用国家人口普查登记册确定了匹配的人口控制。根据ICD代码识别到2019年的骨折。Cox回归模型用于评估RA患者与对照组的骨折风险。以及评估RA人群骨折的潜在预测因素。
结果：RA患者骨折风险增加（完全校正风险比（HR）1.52，95%CI1.13；2.06）。在RA队列中，年龄高,低体重指数，在多变量分析中，低骨密度是未来骨折的重要基线预测因子，但基线RA疾病特征没有。随着时间的推移，更严重的残疾(即更高的健康评估问卷(HAQ)评分)与骨折风险增加显著相关(年龄性别调整后的HR1.33/SD,95%CI1.09;1.63)，BMDZ评分随时间与骨折呈负相关。
结论：RA患者的骨折风险高于对照组。RA患者的骨折风险与基线时和随时间的BMD有关。此外,随着时间的推移,残疾恶化(通过HAQ衡量)与较高的骨折风险相关.
方法：RA患者的初始队列（N=233；164名女性/69名男性，1995-2005年招募)根据结构化计划进行评估，包括重复的临床评估和骨矿物质密度（BMD）的测量，从诊断到10年后。使用国家人口普查登记册确定了匹配的人口控制。根据ICD代码识别到2019年的骨折。Cox回归模型用于评估RA患者与对照组的骨折风险。以及评估RA人群骨折的潜在预测因素。
结果：RA患者骨折风险增加（完全校正风险比（HR）1.52，95%CI1.13；2.06）。在RA队列中，年龄高,低体重指数，在多变量分析中，低骨密度是未来骨折的重要基线预测因子，但基线RA疾病特征没有。随着时间的推移，更严重的残疾(即更高的健康评估问卷(HAQ)评分)与骨折风险增加显著相关(年龄性别调整后的HR1.33/SD,95%CI1.09;1.63)，BMDZ评分随时间与骨折呈负相关。
结论：RA患者的骨折风险高于对照组。RA患者的骨折风险与基线时和随时间的BMD有关。此外,随着时间的推移,残疾恶化(通过HAQ衡量)与较高的骨折风险相关.
