Childhood-Onset Arthritis is Associated with an Elevated Risk of Fracture: A Population-Based Study Using the General Practice Research Database

J M Burnham ^1*, J Shults ², R Weinstein ², J D Lewis ² and M B Leonard ¹

¹ The Children's Hospital of Philadelphia, United States
² University of Pennsylvania School of Medicine, United States

^* To whom correspondence should be addressed. E-mail: burnhams{at}email.chop.edu.

Accepted 5 March 2006

Abstract

Objective: Childhood-onset arthritis is associated with low bone mass and strength. Our objective was to determine whether childhood-onset arthritis is associated with greater fracture risk.

Methods: This retrospective cohort study identified all subjects with onset of arthritis between 1 and 19 years of age in the United Kingdom General Practice Research Database. Controls consisted of all sex- and age-matched subjects from a practice that included a subject with arthritis. Incidence rate ratios (IRR) for first fracture were generated using Mantel Haenszel methods and Poisson regression.

Results: 1939 subjects with arthritis (51% female) and 207,072 controls (53% female) were identified. The median age at arthritis diagnosis was 10.9 years. A total of 129 (6.7%) first fractures were noted in subjects with arthritis compared with 6,910 (3.3%) in controls over a median follow up durations of 3.90 and 3.95 years in the subjects with arthritis and controls, respectively. The IRR (95% CI) for first fracture among subjects with arthritis, compared with controls, according to the age at initiation of follow up were: 1.49 (0.91, 2.31) for age < 10 years, 3.13 (2.21, 4.33) at 10 -15 years, 1.75 (1.18, 2.51) at 15 - 20 years, 1.40 (0.91, 2.08) at 20 - 45 years, and 3.97 (2.23, 6.59) at > 45 years.

Conclusions: Childhood-onset arthritis is associated with a clinically significant increased risk of fracture in children, adolescents and possibly adults. Studies are urgently needed to characterize the determinants of structural bone abnormalities in childhood arthritis and devise prevention and treatment strategies.

Keywords: Arthritis, child, epidemiology, fracture, osteoporosis

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