Skip to main content
PMC home page
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 1995 Jan;54(1):49–52. doi: 10.1136/ard.54.1.49

Rheumatoid arthritis, corticosteroid therapy and hip fracture.

C Cooper 1, C Coupland 1, M Mitchell 1
PMCID: PMC1005512  PMID: 7880122

Abstract

OBJECTIVE--To identify the risk of hip fracture in patients with rheumatoid arthritis and those taking corticosteroids. METHODS--In a population based case-control study, we compared 300 consecutive patients with hip fracture aged 50 years and over from a defined district and 600 age and sex matched community controls. RESULTS--The risk of hip fracture was increased in patients with rheumatoid arthritis (odds ratio (OR) 2.1; 95% confidence interval (CI) 1.0 to 4.7) and those receiving corticosteroids (OR 2.7; 95% CI 1.2 to 5.8). The risk attributable to rheumatoid arthritis was markedly reduced by adjusting for functional impairment, while that for steroid use remained after adjusting for body mass index, smoking, alcohol, and functional status. CONCLUSIONS--Hip fracture risk is approximately doubled amongst patients with rheumatoid arthritis and among those taking steroids. These risk increases are, to some extent, independent of each other. In rheumatoid arthritis, the risk was most closely associated with functional impairment, whereas steroid use did not appear to be confounded by this variable.

Full text

PDF
49

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adinoff A. D., Hollister J. R. Steroid-induced fractures and bone loss in patients with asthma. N Engl J Med. 1983 Aug 4;309(5):265–268. doi: 10.1056/NEJM198308043090502. [DOI] [PubMed] [Google Scholar]
  2. Als O. S., Gotfredsen A., Riis B. J., Christiansen C. Are disease duration and degree of functional impairment determinants of bone loss in rheumatoid arthritis? Ann Rheum Dis. 1985 Jun;44(6):406–411. doi: 10.1136/ard.44.6.406. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Butler R. C., Davie M. W., Worsfold M., Sharp C. A. Bone mineral content in patients with rheumatoid arthritis: relationship to low-dose steroid therapy. Br J Rheumatol. 1991 Apr;30(2):86–90. doi: 10.1093/rheumatology/30.2.86. [DOI] [PubMed] [Google Scholar]
  4. CURTISS P. H., Jr, CLARK W. S., HERNDON C. H. Vertebral fractures resulting from prolonged cortisone and corticotropin therapy. J Am Med Assoc. 1954 Oct 2;156(5):467–469. doi: 10.1001/jama.1954.02950050007002. [DOI] [PubMed] [Google Scholar]
  5. Cooper C., Barker D. J., Wickham C. Physical activity, muscle strength, and calcium intake in fracture of the proximal femur in Britain. BMJ. 1988 Dec 3;297(6661):1443–1446. doi: 10.1136/bmj.297.6661.1443. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Cooper C., Poll V., McLaren M., Daunt S. O., Cawley M. I. Alterations in appendicular skeletal mass in patients with rheumatoid, psoriatic, and osteoarthropathy. Ann Rheum Dis. 1988 Jun;47(6):481–484. doi: 10.1136/ard.47.6.481. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Garton M. J., Reid D. M. Bone mineral density of the hip and of the anteroposterior and lateral dimensions of the spine in men with rheumatoid arthritis. Effects of low-dose corticosteroids. Arthritis Rheum. 1993 Feb;36(2):222–228. doi: 10.1002/art.1780360213. [DOI] [PubMed] [Google Scholar]
  8. Hall G. M., Spector T. D., Griffin A. J., Jawad A. S., Hall M. L., Doyle D. V. The effect of rheumatoid arthritis and steroid therapy on bone density in postmenopausal women. Arthritis Rheum. 1993 Nov;36(11):1510–1516. doi: 10.1002/art.1780361105. [DOI] [PubMed] [Google Scholar]
  9. Hooyman J. R., Melton L. J., 3rd, Nelson A. M., O'Fallon W. M., Riggs B. L. Fractures after rheumatoid arthritis. A population-based study. Arthritis Rheum. 1984 Dec;27(12):1353–1361. doi: 10.1002/art.1780271205. [DOI] [PubMed] [Google Scholar]
  10. KATZ S., FORD A. B., MOSKOWITZ R. W., JACKSON B. A., JAFFE M. W. STUDIES OF ILLNESS IN THE AGED. THE INDEX OF ADL: A STANDARDIZED MEASURE OF BIOLOGICAL AND PSYCHOSOCIAL FUNCTION. JAMA. 1963 Sep 21;185:914–919. doi: 10.1001/jama.1963.03060120024016. [DOI] [PubMed] [Google Scholar]
  11. Luengo M., Picado C., Del Rio L., Guañabens N., Montserrat J. M., Setoain J. Vertebral fractures in steroid dependent asthma and involutional osteoporosis: a comparative study. Thorax. 1991 Nov;46(11):803–806. doi: 10.1136/thx.46.11.803. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Michel B. A., Bloch D. A., Wolfe F., Fries J. F. Fractures in rheumatoid arthritis: an evaluation of associated risk factors. J Rheumatol. 1993 Oct;20(10):1666–1669. [PubMed] [Google Scholar]
  13. Reid D. M., Kennedy N. S., Smith M. A., Tothill P., Nuki G. Total body calcium in rheumatoid arthritis: effects of disease activity and corticosteroid treatment. Br Med J (Clin Res Ed) 1982 Jul 31;285(6338):330–332. doi: 10.1136/bmj.285.6338.330. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Sambrook P. N., Eisman J. A., Champion G. D., Yeates M. G., Pocock N. A., Eberl S. Determinants of axial bone loss in rheumatoid arthritis. Arthritis Rheum. 1987 Jul;30(7):721–728. doi: 10.1002/art.1780300701. [DOI] [PubMed] [Google Scholar]
  15. Saville P. D., Kharmosh O. Osteoporosis of rheumatoid arthritis: influence of age, sex and corticosteroids. Arthritis Rheum. 1967 Oct;10(5):423–430. doi: 10.1002/art.1780100504. [DOI] [PubMed] [Google Scholar]
  16. Skibsted Als O., Gotfredsen A., Christiansen C. Relationship between local and total bone mineral in patients with rheumatoid arthritis and normal subjects. Clin Rheumatol. 1983 Sep;2(3):265–271. doi: 10.1007/BF02041401. [DOI] [PubMed] [Google Scholar]
  17. Spector T. D., Hall G. M., McCloskey E. V., Kanis J. A. Risk of vertebral fracture in women with rheumatoid arthritis. BMJ. 1993 Feb 27;306(6877):558–558. doi: 10.1136/bmj.306.6877.558. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Verstraeten A., Dequeker J. Vertebral and peripheral bone mineral content and fracture incidence in postmenopausal patients with rheumatoid arthritis: effect of low dose corticosteroids. Ann Rheum Dis. 1986 Oct;45(10):852–857. doi: 10.1136/ard.45.10.852. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Wickham C., Cooper C., Margetts B. M., Barker D. J. Muscle strength, activity, housing and the risk of falls in elderly people. Age Ageing. 1989 Jan;18(1):47–51. doi: 10.1093/ageing/18.1.47. [DOI] [PubMed] [Google Scholar]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group

RESOURCES