Bone Abstracts

The femoral neck fractures (FNF) are one of the most common non-traumatic fractures in elderly people. Frequently the patients with fractures of this localization need surgical treatment and long-term rehabilitation. It’s widely known that FNF in patients with rheumatoid arthritis (RA) occur more often than in the population.

Background: To determine the frequency of FNF in patients with RA and to characterize the patients with RA and with FNF at the time of the fracture occurrence.

Methods: 254 women aged 40–75 years old with RA in clinical database of Institute Rheumatology (Moscow) were included in the study. It was examined anamnesis, bone mineral density (BMD) for all patients.

Results: Ten patients (3.9%) from 254 had FNF. The mean age of the patients at time of fracture was 50.5±16.0 years (from 22 to 67 years). All fractures occurred after the diagnosis of RA. The mean duration of RA at the time of fractures was 12.9±7.4 years. 70% of the fractures occurred during treatment with glucocorticoids (GCs; the mean duration of GC therapy was 8.3±5.8 years). three patients with FNF have never taken GCs. In 30% of the cases the fractures were before menopause. Seven patients had femoral or tibial osteonecrosis. It was found three cases of nephropathy (two cases of them were amyloidosis). Four women with FNF have normal values BMD or osteopenia. Osteoporosis in femoral neck was diagnosed in five cases only, and osteoporosis in lumbar area – in 4 of 10 cases.

Conclusions: The FNF in patients with RA occur in younger age than in the population, frequently before menopause, on the background of long duration of RA and GC treatment. These cases associate with more severe course disease with complications. The FNF in patients with RA are not always associated with osteoporosis and can occur with normal BMD values.