How does rheumatoid arthritis and its management affect the risk of falls and fractures?

This study investigated how rheumatoid arthritis (RA)and its treatment may affect bone mineral density (BMD). They found that RA was associated with a reduced BMD and an increased risk of falls and fractures. 

Rheumatoid arthritis (RA) is a chronic condition caused by inflammation. This leads to painful swelling in the joints of the body. Joint tissue will degenerate (become damaged) over time. RA is treated with drugs that reduce inflammation. This can slow joint degeneration. These drugs are called disease-modifying anti-rheumatic drugs (DMARDs). There are many types of DMARDs. They are sometimes classified as synthetic (csDMARDs) or biological (bDMARDs).

RA has been associated with reduced bone mineral density (BMD). Low BMD leads to weak and brittle bones. RA has also been associated with a higher rate of falls and bone fractures. Most of these studies did not investigate specific DMARDs. These studies were conducted before bDMARDs were widely used. It is unclear if RA treatment is associated with BMD and falls and fracture risk. 

This study included 502,543 participants. Of these, 5,492 people with RA. Participants were interviewed to obtain relevant information. This included information on RA disease and medication. A quantitative heel ultrasound (QHU) was performed to assess BMD. The occurrence of falls and fractures was also evaluated. 

RA was associated with lower BMD in men and women. Participants with RA were 54% more likely to have reported a fall in the last year. Women with RA were 76% more likely to have had a bone fracture in the past year. 

Steroid and csDMARD treatment were associated with a lower BMD. bDMARDs were not associated with changes in BMD. No medication was associated with higher rates of falls and bone fractures. 

The authors concluded that RA was associated with reduced BMD and a higher risk of falls and fractures.

Medication and falls and fractures were self-reported. Patients may not always be accurate in their reporting. The number of patients on bDMARDs was low (124/5492). More studies are needed to confirm the findings in this study. 

If you have any concerns regarding RA please discuss this with your doctor.