Meta-analysis on the Risk Factors for Fracture in Patients with Rheumatoid Arthritis

Abstract

Objective: This study was conducted by using a meta-analysis to calculate the mean effect sizes of the risk factors for fracture of patients with rheumatoid arthritis (RA) and to perform tests for the significance of the calculated mean effect sizes. Methods: Eleven studies that directly examined the relationships between fracture and risk factors were selected from 179 related studies identified from PubMed, MEDLINE, COCHRAN and CINHAL with the key words being 'rheumatoid arthritis', 'fracture' and 'risk factors'. Results: The mean effect size of age on fracture was significant. The mean effect sizes of steroid use and the duration of RA on fracture were also significant. However, all of these effect sizes (age, the use of steroid and the duration of disease) were small (bar D=0.15, 0.16 and 0.12, respectively). The mean effect size of the BMD at the lumbar spine was significant and the effect of the BMD at the L-spine was of medium size (bar D=0.47). The mean effect sizes of the other risk factors such as disability, disease activity, the BMD at the femur neck, BMI and a smoking habit were not significant. Conclusion: From the study results, it was noted that the efforts to prevent fracture of RA patients should focus on patients with an older age, the patients who used steroid, the patients with a longer duration of RA and the patients who present with low BMD at the lumbar spine.