LAUSR

Patients with rheumatoid arthritis (RA) who have sarcopenia and stiff or painful joints might be at increased risk of falls and fractures.The present study aimed to prospectively identify the incidence of clinical fractures and associated risk factors in patients with RA in a cohort study named the TOMORROW (UMIN000003876) that started in 2010.We evaluated anthropometric parameters, bone mineral density (BMD), disease activity, RA medication at baseline and observed the incidence of clinical fractures during nine years in 202 patients with RA (mean age, 58.6 y; medication with biological agents, 54.9%) and 202 age- and sex-matched non-RA volunteers (mean age, 57.4 y). We compared the incidence of clinical fractures between patients with RA and controls for nine years, and analyzed the risk factors for fractures using Cox proportional hazard model.The incidence of clinical fractures in RA patients was significantly higher compared to controls (27.5 vs 18.3%, p=0.04). However, Cox proportional hazard model, adjusted by age, sex, smoking and body mass index, revealed that low BMD at thoracic vertebrae (< 0.7 g/cm2) significantly associated to the incidence of clinical fractures (hazard ratio [HR], 1.86, p=0.02), but not RA morbidity (HR 1.47, p=0.10) (Table 1). Among patients with RA, low BMD at the thoracic vertebrae (< 0.7 g/cm2) was the most prominent risk factor for clinical fractures (HR, 2.66, p=0.02) (Table 1). Although the use of glucocorticoid (GC) at baseline (HR, 1.68, p=0.09) was not a significant risk factor for fractures, a mean GC dose (≥ 2 mg/day) at entry increased risk for clinical fractures in the patients (HR, 1.91, p=0.04) (Table 1).RA per se was not a risk factor for clinical fractures in this cohort. Low BMD at the thoracic vertebrae and the use of GC with even low dose at entry were apparently significant risk factors for the incidence of clinical fractures among patients with RA.Kenji Mamoto: None declared, Tatsuya Koike Grant/research support from: Takeda Pharmaceutical, Mitsubishi Tanabe Pharma Corporation,Chugai Pharmaceutical, Eisai, Abbott Japan, Teijin Pharma, Banyu Pharmaceutical and Ono Pharmaceutical, Yutaro Yamada: None declared, Tadashi Okano: None declared, Yuko Sugioka: None declared, Masahiro Tada: None declared, Kentaro Inui Speakers bureau: Daiichi Sankyo Co. Ltd., Mitsubishi Tanabe Pharma, Janssen Pharmaceutical K.K., Astellas Pharma Inc., Takeda Pharmaceutical Co. Ltd., Ono Pharmaceutical Co. Ltd., Abbvie GK, Pfizer Inc., Eisai Co.,Ltd., Chugai Pharmaceutical Co., Ltd., Grant/research support from: Janssen Pharmaceutical K.K., Astellas Pharma Inc., Sanofi K.K., Abbvie GK, Takeda Pharmaceutical Co. Ltd., QOL RD Co. Ltd., Mitsubishi Tanabe Pharma, Ono Pharmaceutical Co. Ltd., Eisai Co.,Ltd., Hiroaki Nakamura: None declared