RESEARCH - Stress fractures in RA: a case series and case-control study

March 8, 2005

ls of the Rheumatic Diseases 2004;63:1690-1692

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CONCISE REPORT

Stress fractures in rheumatoid arthritis: a case series and case-control

study

L J Kay, T M Holland and P N Platt

Musculoskeletal Unit, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK

Correspondence to:

Dr P N Platt

Philplatt@...

ABSTRACT

Objective: To review cases of stress fracture in patients with rheumatoid

arthritis (RA) presenting to our service over a 10 year period; to identify

possible risk factors and test these in a case-control study.

Methods: A retrospective case note review of all patients with a final

diagnosis of stress fracture, presenting between 1990 and 1999 was

performed. A case-control study of consecutive patients with RA, matched for

age, sex and duration of disease, attending the same clinics.

Results: Case series: 24 stress fractures were identified in 18 patients,

representing 0.8% of the RA clinic population; all were women, median age

69.5 years (range 47-79). Bone mineral densitometry showed median T scores

of -3.06 and -2.27 SD at the hip and lumbar spine, respectively.

Case-control study: In the stress fractures group, past steroid doses were

higher (p = 0.003). No significant differences in the bone mineral density

(BMD) T score at the hip or lumbar spine were found (p = 0.59, p = 0.77).

Conclusions: Stress fractures are a significant cause of morbidity in RA.

Diagnosis is often delayed and presentation can be misleading. Past steroid

use, particularly at higher doses, confers an increased risk of stress

fracture, but the increased risk is not attributable to osteoporosis as

assessed by BMD.

Not an MD

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Mayo Clinic in Rochester

s Hopkins Medicine

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