Fracture risk heightened in inflammatory disorders

Persons who have chronic inflammatory diseases, such as rheumatologic disorders and inflammatory bowel diseases (IBD), are at increased risk for fracture. Risk factors include treatment with long-term systemic corticosteroids, which may lead to decreased bone mineral density; microarchitectural weakness; bone remodeling; bone turnover; and mineralization.

Weiss and colleagues examined the incidence of hip and vertebral fractures in persons with a spectrum of rheumatologic disorders and IBD, including rheumatoid arthritis, systemic lupus erythematosus, Crohn disease, and ulcerative colitis. In all, 53,108 patients who had fractures were compared with 370,602 age- and sex-matched controls.

The risk of fracture was higher for patients with a rheumatologic disorder than for those with IBD. There was a statistically significant increase in risk of fracture for all rheumatologic diseases (odds ratio range, 2.6 for systemic sclerosis to 4 for ankylosing spondylitis [AS]). The largest increased risk of vertebral fractures was seen in AS and of hip fractures in juvenile idiopathic arthritis. The risk was increased in persons with Crohn disease or ulcerative colitis compared with controls and in patients who had a diagnosis of hypertension.

The authors noted that fracture prevention strategies may be of benefit in patients with these disorders and warrant further research.