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Rheumatoid arthritis
Original article
Trends in hip fracture in patients with rheumatoid arthritis: results from the Spanish National Inpatient Registry over a 17-year period (1999–2015). TREND-AR study
  1. Ramón Mazzucchelli1,
  2. Elia Pérez Fernandez2,
  3. Natalia Crespí-Villarías3,
  4. Javier Quirós-Donate1,
  5. Alberto García Vadillo4,
  6. María Espinosa5,
  7. Marina Peña6,
  8. Cristina Macía-Villa7,
  9. Jose Luis Morell-Hita8,
  10. Cristina Martinez-Prada9,
  11. Virginia Villaverde10,
  12. Inmaculada Morado Quiroga9,
  13. Olalla Guzón-Illescas6,
  14. Carmen Barbadillo5,
  15. Manuel Fernández Prada11,
  16. Hilda Godoy5,
  17. Angela Herranz Varela12,
  18. María Galindo Izquierdo13 and
  19. Gil Rodriguez Caravaca14
  1. 1 Department of Rheumatology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
  2. 2 Department of Clinical Research, Hospital Universitario Fundación Alcorcón, Madrid, Spain
  3. 3 Centro de Salud La Rivota (Alcorcón), Madrid, Spain
  4. 4 Department of Rheumatology, Hospital Universitario de la Princesa, Madrid, Spain
  5. 5 Department of Rheumatology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
  6. 6 Department of Rehabilitation, Hospital Universitario Fundación Alcorcón, Madrid, Spain
  7. 7 Department of Rheumatology, Hospital Universitario Severo Ochoa, Madrid, Spain
  8. 8 Department of Rheumatology, Hospital Universitario Ramón y Cajal, Madrid, Spain
  9. 9 Department of Rheumatology, Hospital Universitario Clínico San Carlos, Madrid, Spain
  10. 10 Department of Rheumatology, Hospital Universitario de Móstoles, Madrid, Spain
  11. 11 Department of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain
  12. 12 Department of Rheumatology, Hospital Universitario del Henares, Madrid, Spain
  13. 13 Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid, Spain
  14. 14 Department of Preventive Medicine and Public Health, Universidad Rey Juan Carlos I, Madrid, Spain
  1. Correspondence to Dr Ramón Mazzucchelli; rmazzucchelli{at}fhalcorcon.es

Abstract

Purpose To analyse trends in hip fracture (HF) rates in patients with rheumatoid arthritis (RA) over an extended time period (17 years).

Methods This observational retrospective survey was performed by reviewing data from the National Surveillance System for Hospital Data, which includes more than 98% of Spanish hospitals. All hospitalisations of patients with RA and HF that were reported from 1999 to 2015 were analysed. Codes were selected using the Ninth International Classification of Diseases, Clinical Modification: ICD-9-CM: RA 714.0 to 714.9 and HF 820.0 to 820.3. The crude and age-adjusted incidence rate of HF was calculated by age and sex strata over the last 17 years. General lineal models were used to analyse trends.

Results Between 1999 and 2015, 6656 HFs occurred in patients with RA of all ages (84.25% women, mean age 77.5 and 15.75% men, mean age 76.37). The age-adjusted osteoporotic HF rate was 221.85/100 000 RA persons/ year (women 227.97; men 179.06). The HF incidence rate increased yearly by 3.1% (95% CI 2.1 to 4.0) during the 1999–2015 period (p<0.001) and was more pronounced in men (3.5% (95% CI 2.1 to 4.9)) than in women (3.1% (95% CI 2.3 to 4.1)). The female to male ratio decreased from 1.54 in 1999 to 1.14 in 2015. The average length of hospital stays (ALHS) decreased (p<0.001) from 16.76 days (SD 15.3) in 1999 to 10.78 days (SD 7.72) in 2015. Age at the time of hospitalisation increased (p<0.001) from 75.3 years (SD 9.33) in 1999 to 79.92 years (SD 9.47) in 2015. There was a total of 326 (4.9%) deaths during admission, 247 (4.4%) in women and 79 (7.5%) in men (p<0.001).

Conclusion In Spain, despite the advances that have taken place in controlling disease activity and in treating osteoporosis, the incidence rate of HF increased in both male and female patients with RA.

  • Osteoporosis
  • Rheumatoid arthritis
  • Trend
  • Hip fracture

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/rmdopen-2018-000671

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    Footnotes

    • Funding This work has a help for the research provided by the Society of Rheumatology of the Community of Madrid (SORCOM).

    • Competing interests None declared.

    • Ethics approval Comité Etico del Hospital Universitario Fundación Alcorcón.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent Not required.

    • Contributors RM and NC-V designed research; EPF, RM, NC-V and JQ-D analysed data. ME, MP,CM-V, JLM-H, CM-P, VV, IMQ, OG-I, CB, MFP, HG, AHV, MGI contributed with the CMBD of their respective hospitals; RM, AG-V and GRC wrote the paper.

    • Data sharing statement None.