Is Fragility Fracture a Strong Risk Factor for a Cardiovascular Event in Rheumatoid Arthritis? The Challenge of Dealing with Multiple Comorbidities

Abstract

Multiple comorbidities are among the most important challenges today because comorbidity is age-related and the population is aging1. In patients with rheumatoid arthritis (RA), the risk of both fragility fractures (FF) and cardiovascular (CV) manifestations is elevated2,3,4,5, but are these comorbidities separate processes, or are they interrelated? If these events (partly) share a common pathogenesis, an FF is not only a strong risk factor for a subsequent fracture6, but also for a CV event. As a consequence, it might be useful to determine the CV risk after a recent fracture. The study by Ni Mhuircheartaigh, et al 7 brings up exciting data that show that CV risk, both of myocardial infarction (MI) and heart failure, is elevated after an FF in patients with RA. In an observational study in Olmsted County (USA) from 1995 to 2007, 1171 patients with incident RA and 1171 controls were included. At baseline, the patients had hypertension, obesity, and dyslipidemia more often, but RA patients with a previous event were excluded. During followup, 406 and 346 FF were observed, and 286 and … Address correspondence to Prof. W.F. Lems, Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, 3A 64 Postbox 7057, 1007 MB, Amsterdam, the Netherlands. E-mail: wf.lems{at}vumc.nl