類風濕性關節炎患者骨折風險的長期趨勢分析：臺灣全民健保資料庫回溯性研究

Temporal Trends in Fracture Risk Among Patients with Rheumatoid Arthritis A Retrospective Analysis of the Taiwan National Health Insurance Research Database

背景：類風濕性關節炎（RA）患者因慢性發炎、長期藥物使用及活動功能受限等因素，具有較高的骨質疏鬆性骨折風險，然而針對長期骨折風險與骨折後死亡率變化的資料仍有限。
目的：本研究旨在評估RA患者與一般人群相比，骨質疏鬆性骨折發生率及骨折後死亡風險的長期變化趨勢。
方法：本研究利用臺灣全民健康保險資料庫（NHIRD），進行2003年至2021年的回溯性世代研究，追蹤年齡50歲以上RA患者發生髖骨、脊椎及橈尺骨骨折之情形，並計算標準化發生比（SIR）。骨折後存活率以Kaplan–Meier曲線與Cox迴歸分析，依年齡、性別、骨折類型與年度將每位RA患者配對10位非RA對照進行比較。
結果：本研究共納入10,874位RA骨折患者（平均年齡71.3歲，女性占85.3%）。RA患者整體骨折風險較一般人群高，髖骨骨折SIR由2003–2006年間的2.36下降至2017–2021年間的1.83；脊椎骨折SIR亦呈下降趨勢（1.77降至1.33）；橈尺骨骨折SIR則略微上升（1.18升至1.40）。女性患者在髖骨及脊椎骨折風險下降較明顯。此外，RA患者骨折後死亡風險明顯增加，其中脊椎骨折的危險比（HR）為2.29，橈尺骨骨折為1.60，髖骨骨折則為1.35。
結論：儘管RA患者骨折風險逐漸下降，但相對一般人群仍持續偏高，且骨折後死亡風險明顯增加。未來需持續強化骨折防治及骨折後醫療照護措施。

Objective: To evaluate long-term trends in osteoporotic fracture incidence and post-fracture mortality among rheumatoid arthritis (RA) patients compared with the general population.
Methods: We conducted a retrospective cohort study using Taiwan’s National Health Insurance Research Database (2003–2021). RA patients aged≥50 years were followed for incident hip, vertebral, and radius/ ulna fractures. Standardized incidence ratios (SIRs) were calculated using general population rates. Postfracture survival was assessed via Kaplan–Meier and Cox models, matching each RA patient with ten non- RA individuals by age, sex, fracture type, and calendar year.
Results: Among 10,874 RA patients with fractures (85.3% female; mean age, 71.3 years), SIRs declined over time for hip (2.36 to 1.83) and vertebral (1.77 to 1.33) fractures but rose for radius/ulna (1.18 to 1.40). Female patients showed greater improvements. RA patients had significantly higher post-fracture mortality (HRs: vertebra 2.29; radius/ulna 1.60; hip 1.35).
Conclusion: Despite declining fracture rates, RA patients remain at elevated fracture risk and mortality. Enhanced prevention and post-fracture care remain critical.