Background Osteoporotic fracture is a recognised complication of RA, and hip fracture is a considerable economic burden for health services.
Objectives To examine the incidence rates and economic burden of, and risk factors for osteoporotic fracture in patients with RA in two UK inception cohorts.
Methods 1465 DMARD naïve patients were recruited into the Early RA Study (ERAS, 9 centres) from 1986-1998 and 1236 patients into the similarly designed early RA Network (ERAN, 23 centres) from 2002-2012. Standard clinical, radiological and laboratory measures were performed yearly for a maximum 25 and 10yrs (median 10 & 3yrs respectively). Major co morbidities and in-patient hospital episodes were recorded yearly, including fracture sites and orthopaedic interventions (OPCS codes). Clinical databases were supplemented and validated with national databases: the National Joint Registry (data available from 2003-2011), Hospital Episode Statistics (data 1997-2011), and the National Death Register (data 1986-2011). Only patients who moved abroad or were not registered with a general practitioner would be absent from national databases. Treatment regimens followed guidelines of the era, mainly conventional DMARD therapies, +/- steroids, and latterly biologics.
Results 182 fractures (#) were recorded in 176 (6.5%) patients: hip (76, 42%), wrist (32, 17.5%), vertebral (22, 12%), others (52,28.5%). 13 hip fractures had hip replacements, 57 dynamic hip screw surgery(DHS) and 6 conservative management. There were no immediate postoperative deaths but hip and vertebral fractures were recorded as contributory causes of death in 12 and 2 respectively. Fracture incidence rates, types of surgery and direct costs over time will be displayed graphically. The median time from baseline to hip fracture was 8yrs (IQR 5-15), with average length of stay (LoS, the main driver for indirect costs) of median 15days in 1986-1994, improving to 8days in 2005-2012, but still considerably greater than national LoS figures for all hip fractures. This equals a total cost of £421,940/€493,191 for 70 procedures relating to hip # based on length of stay (THR for # £90,428/€105,698; DHS # £331,512/€387,456). Fracture risk included traditional factors (age, gender) and for hip fracture also included disease severity measures in 1st year: high rheumatoid factor (OR 1.7, 95%CI 1.1-2.9), erosions (OR 2.4, 95%CI 1.4-4.0), steroid use (OR 2.7, 95%CI 1.1-6.5), high HAQ (OR 1.7, 95%CI 1.1-2.9) & ESR (OR 1.9, 95%CI 1.1-3.1), low haemoglobin (OR 1.99, 95%CI 1.2-3.1), the latter an unusual finding.
Conclusions Osteoporotic fracture complicated RA in 6.5% over 25yrs, mainly hip fractures, and not a late complication of RA. Most required major orthopaedic interventions and health costs. Risk factors for hip fracture included disease severity measures, suggesting a greater need for more active therapies for RA control and bone protection.
Acknowledgements With acknowledgement to the clinicians and nurses of the ERAS & ERAN cohorts.
Disclosure of Interest None Declared