Skip to main content

Advertisement

SpringerLink
Log in

Ten-year incidences of self-reported non-vertebral fractures in Japanese patients with rheumatoid arthritis: discrepancy between disease activity control and the incidence of non-vertebral fracture

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

Despite improvements in rheumatoid arthritis disease activity of in the past 10 years, the incidence of self-reported non-vertebral fractures did not decrease in our cohort of 9,987 patients. This study may indicate that osteoporosis treatment and non-vertebral fracture prevention remain important regardless of the rheumatoid arthritis disease activity.

Introduction

Although rheumatoid arthritis (RA) is a risk factor for osteoporosis and fractures, few studies have described the association between disease activity and the fracture incidence in patients with RA. This study aimed to investigate changes in the non-vertebral fracture incidence between 2001 and 2010 in our Institute of Rheumatology Rheumatoid Arthritis (IORRA) cohort.

Methods

The IORRA is a prospective observational cohort study of Japanese RA patients. A total of 9,987 patients with RA were enrolled in this cohort from 2000 to 2010. The clinical parameter and non-vertebral fracture occurrence data were collected biannually through self-reported questionnaires. Incidences of self-reported non-vertebral fractures were also analyzed via standardization according to gender, age, and disease activity during each 2-year period.

Results

From 2001 to 2010, the percentage of patients with 28-joint disease activity score remission increased from 7.8 to 39.7 %, prednisolone intake decreased from 51.4 to 41.3 %, and bisphosphonate intake increased from 5.0 to 23.4 %. The non-vertebral fracture incidence rates were 24.6/1,000 person-years in 2001 and 35.5/1,000 person-years in 2010, with no apparent change even after standardization. The overall non-vertebral fracture incidence was significantly higher in the autumn/winter than in the spring/summer (p = 0.02).

Conclusion

Despite improvements in disease activity and functional disability, the non-vertebral fracture incidence exhibited no apparent change between 2001 and 2010 in our patients with RA. Osteoporosis treatment and non-vertebral fracture prevention remain important regardless of the disease control in patients with RA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Cooper C, Coupland C, Mitchell M (1995) Rheumatoid arthritis, corticosteroid therapy and hip fracture. Ann Rheum Dis 54:49–52

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Hooyman JR, Melton LJ 3rd, Nelson AM, O’Fallon WM, Riggs BL (1984) Fractures after rheumatoid arthritis. A population-based study. Arthritis Rheum 27:1353–1361

    Article  CAS  PubMed  Google Scholar 

  3. 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

    Article  PubMed Central  PubMed  Google Scholar 

  4. 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

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  5. 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

    Article  PubMed  Google Scholar 

  6. 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

    Article  PubMed Central  PubMed  Google Scholar 

  7. Weiss RJ, Wick MC, Ackermann PW, Montgomery SM (2010) Increased fracture risk in patients with rheumatic disorders and other inflammatory diseases—a case–control study with 53,108 patients with fracture. J Rheumatol 37:2247–2250

    Article  PubMed  Google Scholar 

  8. 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

    PubMed  Google Scholar 

  9. 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

    Article  PubMed  Google Scholar 

  10. 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

    Article  PubMed  Google Scholar 

  11. 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

    Article  CAS  PubMed  Google Scholar 

  12. 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

    Article  PubMed  Google Scholar 

  13. Ochi K, Horiuchi Y, Matsumura T, Nakamura M, Takei T, Yabe H (2012) Distal radius fracture after Sauve-Kapandji procedure in a rheumatoid arthritis patient. Mod Rheumatol 22:290–294

    Article  PubMed  Google Scholar 

  14. Yamanaka H, Inoue E, Singh G, Tanaka E, Nakajima A, Taniguchi A, Hara M, Tomatsu T, Kamatani N (2007) Improvement of disease activity of rheumatoid arthritis patients from 2000 to 2006 in a large observational cohort study IORRA in Japan. Mod Rheumatol 17:283–289

    Article  PubMed  Google Scholar 

  15. 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

    Article  PubMed  Google Scholar 

  16. Lipsky PE, van der Heijde DM, St Clair EW, Furst DE, Breedveld FC, Kalden JR, Smolen JS, Weisman M, Emery P, Feldmann M, Harriman GR, Maini RN (2000) Infliximab and methotrexate in the treatment of rheumatoid arthritis. Anti-tumor necrosis factor trial in rheumatoid arthritis with concomitant therapy study group. N Engl J Med 343:1594–1602

    Article  CAS  PubMed  Google Scholar 

  17. Genovese MC, Rubbert-Roth A, Smolen JS, Kremer J, Khraishi M, Gomez-Reino J, Sebba A, Pilson R, Williams S, Van Vollenhoven R (2013) Longterm safety and efficacy of tocilizumab in patients with rheumatoid arthritis: a cumulative analysis of up to 4.6 years of exposure. J Rheumatol 40:768–780

    Article  CAS  PubMed  Google Scholar 

  18. Tanaka E, Mannalithara A, Inoue E, Hara M, Tomatsu T, Kamatani N, Singh G, Yamanaka H (2008) Efficient management of rheumatoid arthritis significantly reduces long-term functional disability. Ann Rheum Dis 67:1153–1158

    Article  CAS  PubMed  Google Scholar 

  19. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, Healey LA, Kaplan SR, Liang MH, Luthra HS et al (1988) The american rheumatism association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324

    Article  CAS  PubMed  Google Scholar 

  20. Furuya T, Hosoi T, Saito S, Inoue E, Taniguchi A, Momohara S, Yamanaka H (2011) Fracture risk assessment and osteoporosis treatment disparities in 3,970 Japanese patients with rheumatoid arthritis. Clin Rheumatol 30:1105–1111

    Article  PubMed  Google Scholar 

  21. Momohara S, Inoue E, Ikari K, Yano K, Tokita A, Honjo Y, Sakuma Y, Hiroshima R, Iwamoto T, Seto Y, Tanaka E, Taniguchi A, Yamanaka H (2012) Comparison of characteristics and therapeutic efficacy in rheumatoid arthritis patients treated by rheumatologists and those treated by orthopedic surgeons under a team medicine approach at the same institute. Mod Rheumatol 22:209–215

    Article  PubMed  Google Scholar 

  22. van der Heijde DM, van ’t Hof MA, van Riel PL, Theunisse LA, Lubberts EW, van Leeuwen MA, van Rijswijk MH, van de Putte LB (1990) Judging disease activity in clinical practice in rheumatoid arthritis: first step in the development of a disease activity score. Ann Rheum Dis 49:916–920

    Article  PubMed Central  PubMed  Google Scholar 

  23. Aletaha D, Smolen JS (2007) The simplified disease activity index (SDAI) and clinical disease activity index (CDAI) to monitor patients in standard clinical care. Best Pract Res Clin Rheumatol 21:663–675

    Article  PubMed  Google Scholar 

  24. Felson DT, Smolen JS, Wells G, Zhang B, van Tuyl LH, Funovits J, Aletaha D, Allaart CF, Bathon J, Bombardieri S, Brooks P, Brown A, Matucci-Cerinic M, Choi H, Combe B, de Wit M, Dougados M, Emery P, Furst D, Gomez-Reino J, Hawker G, Keystone E, Khanna D, Kirwan J, Kvien TK, Landewe R, Listing J, Michaud K, Martin-Mola E, Montie P, Pincus T, Richards P, Siegel JN, Simon LS, Sokka T, Strand V, Tugwell P, Tyndall A, van der Heijde D, Verstappen S, White B, Wolfe F, Zink A, Boers M (2011) American College of Rheumatology/European League against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials. Arthritis Rheum 63:573–586

    Article  PubMed Central  PubMed  Google Scholar 

  25. 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

    Article  PubMed  Google Scholar 

  26. Urano W, Furuya T, Inoue E, Taniguchi A, Urano T, Kotake S, Sekita C, Inoue S, Hara M, Momohara S, Kamatani N, Yamanaka H (2009) Associations between methotrexate treatment and methylenetetrahydrofolate reductase gene polymorphisms with incident fractures in Japanese female rheumatoid arthritis patients. J Bone Miner Metab 27:574–583

    Article  CAS  PubMed  Google Scholar 

  27. Ochi K, Go Y, Furuya T, Ikari K, Taniguchi A, Yamanaka H, Momohara S (2014) 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

    Article  PubMed  Google Scholar 

  28. Rothman K, Greenland S, Lash T (2008) Modern epidemiology. Lippincott Williams & Wilkins

  29. Cheng CK, McDonald-Blumer H, Boire G, Pope JE, Haraoui B, Hitchon CA, Thorne C, Sun Y, Bykerk VP (2010) Care gap in patients with early inflammatory arthritis with a high fracture risk identified using FRAX((R)). J Rheumatol 37:2221–2225

    Article  PubMed  Google Scholar 

  30. Roussy JP, Bessette L, Bernatsky S, Rahme E, Lachaine J (2013) Biologic disease-modifying anti-rheumatic drugs and the risk of non-vertebral osteoporotic fractures in patients with rheumatoid arthritis aged 50 years and over. Osteoporos Int 24:2483–2492

    Article  PubMed  Google Scholar 

  31. Kim SY, Schneeweiss S, Liu J, Solomon DH (2012) Effects of disease-modifying antirheumatic drugs on nonvertebral fracture risk in rheumatoid arthritis: a population-based cohort study. J Bone Miner Res 27:789–796

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  32. Kawai VK, Grijalva CG, Arbogast PG, Curtis JR, Solomon DH, Delzell E, Chen L, Ouellet-Hellstrom R, Herrinton L, Liu L, Mitchell EF Jr, Stein CM, Griffin MR (2013) Initiation of tumor necrosis factor alpha antagonists and risk of fractures in patients with selected rheumatic and autoimmune diseases. Arthritis Care Res (Hoboken) 65:1085–1094

    Article  CAS  Google Scholar 

  33. Adachi JD, Adami S, Gehlbach S, Anderson FA Jr, Boonen S, Chapurlat RD, Compston JE, Cooper C, Delmas P, Diez-Perez A, Greenspan SL, Hooven FH, LaCroix AZ, Lindsay R, Netelenbos JC, Wu O, Pfeilschifter J, Roux C, Saag KG, Sambrook PN, Silverman S, Siris ES, Nika G, Watts NB (2010) Impact of prevalent fractures on quality of life: baseline results from the global longitudinal study of osteoporosis in women. Mayo Clin Proc 85:806–813

    Article  PubMed Central  PubMed  Google Scholar 

  34. Lane NE, Kelman A (2003) A review of anabolic therapies for osteoporosis. Arthritis Res Ther 5:214–222

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  35. Ochi K, Ikari K, Naomi A, Momohara S (2013) Administration of teriparatide treatment for a challenging case of nonunion of periprosthetic fracture after total knee arthroplasty. Arch Osteoporos 8:159

    Article  PubMed  Google Scholar 

  36. Hagino H, Sakamoto K, Harada A, Nakamura T, Mutoh Y, Mori S, Endo N, Nakano T, Itoi E, Kita K, Yamamoto N, Aoyagi K, Yamazaki K (2010) Nationwide one-decade survey of hip fractures in Japan. J Orthop Sci 15:737–745

    Article  PubMed  Google Scholar 

  37. Hagino H, Katagiri H, Okano T, Yamamoto K, Teshima R (2005) Increasing incidence of hip fracture in Tottori prefecture, Japan: trend from 1986 to 2001. Osteoporos Int 16:1963–1968

    Article  PubMed  Google Scholar 

  38. 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

    Article  CAS  PubMed  Google Scholar 

  39. Lau EM, Lee JK, Suriwongpaisal P, Saw SM, De Das S, Khir A, Sambrook P (2001) The incidence of hip fracture in four asian countries: the Asian osteoporosis study (AOS). Osteoporos Int 12:239–243

    Article  CAS  PubMed  Google Scholar 

  40. Khandelwal S, Chandra M, Lo JC (2012) Clinical characteristics, bone mineral density and non-vertebral osteoporotic fracture outcomes among post-menopausal U.S. South Asian women. Bone 51:1025–1028

    Article  PubMed  Google Scholar 

  41. 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

    Article  CAS  PubMed  Google Scholar 

  42. Honkanen K, Honkanen R, Heikkinen L, Kroger H, Saarikoski S (1999) Validity of self-reports of fractures in perimenopausal women. Am J Epidemiol 150:511–516

    Article  CAS  PubMed  Google Scholar 

  43. 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

    CAS  PubMed  Google Scholar 

  44. Angeli A, Guglielmi G, Dovio A, Capelli G, de Feo D, Giannini S, Giorgino R, Moro L, Giustina A (2006) High prevalence of asymptomatic vertebral fractures in post-menopausal women receiving chronic glucocorticoid therapy: a cross-sectional outpatient study. Bone 39:253–259

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We thank all members of the Institute of Rheumatology, Tokyo Women’s Medical University for their successful management of the IORRA cohort. We also thank Professor Y. Toyama and other members of the Department of Orthopedic Surgery, Keio University School of Medicine for their support.

Source of support

This work was supported in part by grants-in-aid for scientific research from the Japan Society for the Promotion of Science, the Nakatomi Foundation, the Japan Orthopedics and Traumatology Foundation, Inc. No. 277, and the Japan Osteoporosis Foundation to KO as well as from the Japan Osteoporosis Society to TF.

Conflicts of interest

Hisashi Yamanaka has received honoraria for lectures from AbbVie, Chugai, Daiichi Sankyo, Eisai, Mitsubishi Tanabe, Pfizer, Takeda, and Teijin Pharma. Kensuke Ochi, Eisuke Inoue, Takefumi Furuya, Katsunori Ikari, Atsuo Taniguchi, and Shigeki Momohara declare that they have no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Institute of Rheumatology, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan

    K. Ochi, K. Ikari & S. Momohara

  2. Institute of Rheumatology, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan

    E. Inoue, T. Furuya, A. Taniguchi & H. Yamanaka

  3. Department of Orthopedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan

    K. Ochi & Y. Toyama

Authors
  1. K. Ochi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. Inoue
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T. Furuya
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. K. Ikari
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Y. Toyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. Taniguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. H. Yamanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. S. Momohara
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K. Ochi.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

(DOCX 74 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ochi, K., Inoue, E., Furuya, T. et al. Ten-year incidences of self-reported non-vertebral fractures in Japanese patients with rheumatoid arthritis: discrepancy between disease activity control and the incidence of non-vertebral fracture. Osteoporos Int 26, 961–968 (2015). https://doi.org/10.1007/s00198-014-2911-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-014-2911-2

Keywords

Search

Navigation