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Childhood onset arthritis is associated with an increased risk of fracture: a population based study using the
J M Burnham1, J Shults, R Weinstein
1Children's Hospital of Philadelphia, Room 1579 CHOP North, 3535 Market Street, Philadelphia, PA 19104, USA. burnhams@email.chop.edu
Insights
Childhood arthritis significantly increases fracture risk across all age groups. Further research is vital to understand bone health in these patients and develop effective prevention strategies.
Area of Science:
- Rheumatology
- Orthopedics
- Pediatrics
Background:
- Childhood onset arthritis is linked to reduced bone mass and strength.
- Understanding the long-term skeletal consequences of early-onset arthritis is crucial.
Purpose of the Study:
- To investigate the association between childhood onset arthritis and the risk of fractures.
- To quantify fracture risk across different age groups in individuals with a history of childhood arthritis.
Main Methods:
- Retrospective cohort study utilizing the United Kingdom General Practice Research Database.
- Inclusion of individuals with arthritis onset between 1 and 19 years of age, with age and sex-matched controls.
- Incidence rate ratios (IRRs) for first fracture calculated using Mantel-Haenszel methods and Poisson regression.
Main Results:
- 1939 subjects with childhood arthritis and 207,072 controls were analyzed.
- A higher incidence of first fractures was observed in the arthritis cohort (6.7%) compared to controls (3.3%).
- Significantly elevated fracture risk (IRR) was noted, particularly in adolescents (10-15 years: 3.13) and older adults (>45 years: 3.97).
Conclusions:
- Childhood onset arthritis is associated with a clinically significant increase in fracture risk throughout life.
- Urgent research is needed to identify factors contributing to bone abnormalities and to develop targeted prevention and treatment strategies for childhood arthritis patients.
Background:
Childhood onset arthritis is associated with low bone mass and strength.
Objective:
To determine whether childhood onset arthritis is associated with greater fracture risk.
Methods:
In a retrospective cohort study all subjects with onset of arthritis between 1 and 19 years of age in the United Kingdom General Practice Research Database were identified. As controls, all sex and age matched subjects from a practice that included a subject with arthritis were included. Incidence rate ratios (IRRs) for first fracture were generated using Mantel-Haenszel methods and Poisson regression.
Results:
1939 subjects with arthritis (51% female) and 207 072 controls (53% female) were identified. The median age at arthritis diagnosis was 10.9 years. A total of 129 (6.7%) first fractures were noted in subjects with arthritis compared with 6910 (3.3%) in controls over a median follow up of 3.90 and 3.95 years in the subjects with arthritis and controls, respectively. The IRR (95% confidence interval) for first fracture among subjects with arthritis, compared with controls, according to the age at the start of follow up were 1.49 (0.91 to 2.31) for age <10 years, 3.13 (2.21 to 4.33) at 10-15 years, 1.75 (1.18 to 2.51) at 15-20 years, 1.40 (0.91 to 2.08) at 20-45 years, and 3.97 (2.23 to 6.59) at >45 years.
Conclusions:
Childhood onset arthritis is associated with a clinically significant increased risk of fracture in children, adolescents and, possibly, adults. Studies are urgently needed to characterise the determinants of structural bone abnormalities in childhood arthritis and devise prevention and treatment strategies.
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