THU0488 Age at the time of hip fracture in patients with rheumatoid arthritis is greater than it was 10 years ago, but is still younger than that of the general population
Authors: K. Arai, J. Ajiro
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Niigata Prefectural Central Hospital (NPCH) is the principal hospital of Joetsu and Myoko cities in Niigata Prefecture, Japan. It serves a population of 230,186, of whom 70 205 (30.5%) were aged ≥65 years in 2015. About 90% of patients with hip fractures underwent surgery within 48 working hours after admission in NPCH. Between 50% and 60% of all hip fractures in our region are treated at the NPCH, which employs two rheumatologists and treats 500 rheumatoid arthritis (RA) patients. <h3>Objectives</h3> We sought to identify the characteristics of RA patients with hip fractures, as compared to those of the general population and of RA patients treated 10 years previously<sup>1]</sup>. <h3>Methods</h3> Between 2012 and 2015, 789 hip fractures were treated at the NPCH. The mean age of these patients was 84±8.0 years. RA patients with such fractures were compared with fracture patients from the general population. We recorded the neck/trochanter (n/t) ratio, age at fracture, disease duration, steroid and anti-osteoporosis drug-use rates, secondary fracture rate, walking capacity after operation, 1 year and 30 day mortality rates, and infection rate, in both current RA patients and those treated 10 years previously. <h3>Results</h3> Eleven RA cases had hip fractures (mean age: 76±7.0 years; all females); 8 had been treated for RA at NPCH. RA patients constitute 1.4% of the general population, and 1.6% of all RA patients treated at the NPCH. Mean RA duration was 23±20 years. The n/t ratio was 1.2. Three cases aged 60–69 years were of the mutilated type and mean RA duration was 35±18 years. Five cases aged 70–79 years featured amyloidosis associated with hemodialysis (1 case), severe interstitial pneumonia,<sup>1</sup> Parkinson's disease,<sup>1</sup> total knee arthroplasty triggered by RA,<sup>2</sup> and mean RA duration was 17±11 years. Of 3 cases aged 80–89 years, RA onset was after age 80 years in two. At the time of fracture, 7 were receiving anti-osteoporosis treatment; 2 were on teriparatide, 4 on bisphosphonate, and 3 on activated vitamin D. Some patients discontinued anti-osteoporotic medication because of renal failure or side effects; 84% of patients had taken anti-osteoporotic medications prior to fracture. Seven patients were taking steroids (mean prednisolone dose 3.9±2.1 mg/day). Secondary fractures occurred in 2 cases; one had RA of the mutilated type with renal failure; a secondary fracture occurred 4 months later. The 2nd case was taking anti-osteoporotic medication but the secondary fracture occurred 32 months later. At 3 months after surgery, the walking abilities of all patients were the same as prior to fracture. No mortality was recorded at either 30 days or 1 year. No infective complication was noted. <h3>Conclusions</h3> Hip fracture in patients with RA occurs in 1.4% of the general population in Joetsu and Myoko, Japan, ranging from 0.93% in Taiwan<sup>2</sup> to 1.6% in Sweden<sup>3</sup>, and 1.6% of all RA patients, ranging 3.3% in Taiwan<sup>2</sup> to 6.5% in Sweden<sup>3</sup>. The mean age at hip fracture was 76±7.0 years, thus about 8 years younger than that of fracture patients from the general population, but was 72±4.5 years 10 years ago<sup>1</sup>. Among all patients, 64% were on steroids (83% 10 years ago<sup>1</sup>), 84% were on anti-osteoporosis drugs (31% 10 years ago<sup>1</sup>) and the n/t ratio was 1.2 (3.2 10 years ago<sup>1</sup>). <h3>References</h3> [1] Arai K, et al. Mod Rheumatol2007. [2] Lin YC, et al. Osteoporos Int2015. [3] Yamamoto Y, et al. J Rheumatol2015. <h3>Disclosure of Interest</h3> None declared