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

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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

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.

http://ard.bmjjournals.com/cgi/content/abstract/63/12/1690