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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Endocrinol. | doi: 10.3389/fendo.2019.00817

Low Bone Mineral Density, Risk of Falls and Fracture are increased among Individuals with Rheumatoid Arthritis: Findings from UK Biobank

 Michael A. Clynes1*, Karen Jameson1, Daniel Prieto-Alhambra2,  Nicholas C. Harvey1, Cyrus Cooper1, 3 and  Elaine Dennison1
  • 1MRC Lifecourse Epidemiology Unit (MRC), United Kingdom
  • 2Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Medical Sciences Division, University of Oxford, United Kingdom
  • 3Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Medical Sciences Division, University of Oxford, United Kingdom

Objectives. The aim of this study was to investigate associations between rheumatoid arthritis (RA), RA medications and bone mineral density, falls and fractures, using UK Biobank data.
Methods. Diagnosis of RA was made using Hospital Episode Statistics (HES) ICD-10 coding. We assessed RA relationships with estimated bone mineral density (eBMD) from heel quantitative ultrasound measurements, self-reported falls (in last year) and HES recorded fracture, adjusted for age, ethnicity, BMI, smoking status and physical activity.
Results. Of 502,543 participants, 3849 (1.4%) of women and 1643 (0.7%) of men had a diagnosis of RA. Median age of the participants was 57 years (IQR 50 - 63) in women and 58 (IQR 50 - 64) in men. RA was associated with lower eBMD (men: β -0.244, 95% CI -0.378, -0.110 p<0.001; women: β -0.217, 95% CI -0.297, -0.138 p<0.001) a reported fall in the last year (men: OR 1.54, 95% CI 1.26, 1.87 p<0.001; women: OR 1.36, 95% CI 1.19, 1.56 p<0.001) and fracture in women (OR 1.76, 95% CI 1.43, 2.16 p<0.001). Corticosteroid therapy in men (β -0.934, 95% CI -1.565, -0.304 p=0.004) and disease modifying anti-rheumatic drug (DMARD) use in both sexes (men: β -0.437, 95% CI -0.761, -0.112 p=0.008; women: β -0.243, 95% CI -0.421, -0.065 p=0.007), but not biologic therapy, were associated with a lower eBMD with RA.
Conclusions. RA was associated with lower eBMD, increased falls and fracture. Corticosteroid and DMARD therapy, but not biologic therapy, were associated with lower eBMD.

Keywords: Osteoporosis, falls, Bone mineral denisty, Rheumatoid arthritis, Fracture, Biobank

Received: 19 Jul 2019; Accepted: 08 Nov 2019.

Copyright: © 2019 Clynes, Jameson, Prieto-Alhambra, Harvey, Cooper and Dennison. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Michael A. Clynes, MRC Lifecourse Epidemiology Unit (MRC), Southampton, United Kingdom,