Prevalence and Fracture Risk of Osteoporosis in Patients with Rheumatoid Arthritis: A Multicenter Comparative Study of the FRAX and WHO Criteria

Abstract

(1) Background: We evaluated the prevalence and fracture risk of osteoporosis in patients with rheumatoid arthritis (RA), and compared the fracture risk assessment tool (FRAX) criteria and bone mineral density (BMD) criteria established by the World Health Organization (WHO). (2) Methods: This retrospective cross-sectional study, which included 479 RA patients in 5 hospitals, was conducted between January 2012 and December 2016. The FRAX criteria for high-risk osteoporotic fractures were calculated including and excluding the BMD values, respectively. The definition of high risk for fracture by FRAX criteria and BMD criteria by WHO was 10-year probability of ≥ 20% for major osteoporotic fracture or ≥ 3% for hip fracture, and T score ≤ −2.5 or Z score ≤ −2.0, respectively. (3) Results: The mean age was 61.7 ± 11.9 years. The study included 426 female patients (88.9%), 353 (82.9%) of whom were postmenopausal. Osteoporotic fractures were detected in 81 (16.9%) patients. The numbers of candidates for pharmacological intervention using the FRAX criteria with and without BMD and the WHO criteria were 226 (47.2%), 292 (61%), and 160 (33.4%), respectively. Only 69.2%–77% of the patients in the high-risk group using the FRAX criteria were receiving osteoporosis treatments. The following were significant using the WHO criteria: female (OR 3.55, 95% CI 1.46–8.63), age (OR 1.1, 95% CI 1.08–1.13), and BMI (OR 0.8, 95% CI 0.75–0.87). Glucocorticoid dose (OR 1.09, 95% CI 1.01–1.17), age (OR 1.09, 95% CI 1.06–1.12), and disease duration (OR 1.01, 95% CI 1–1.01) were independent risk factors for fracture. (4) Conclusions: The proportion of RA patients with a high risk of osteoporotic fractures was 33.4%–61%. Only 69.2%–77% of candidate patients were receiving osteoporotic treatments while applying FRAX criteria. Independent risk factors for osteoporotic fractures in RA patients were age, the dose of glucocorticoid, and disease duration.

Bone Loss, Osteoporosis, and Fractures in Patients with Rheumatoid Arthritis: A Review

“…It integrates the risks associated with BMD at the femoral neck as well as clinical risk factors such as age, height, weight, sex, smoking status, alcohol drinking, use of glucocorticoids, and history of secondary osteoporosis. FRAXtool ® is useful to set a threshold in order to screen candidates for pharmacological intervention and the proportion of RA patients with a greater risk of osteoporotic fractures detected with FRAXtool ® is higher than with the WHO criteria [ 19 ]. When applied to 238 patients enrolled in the Canadian Early Arthritis Cohort (CATCH) study without using BMD measurements, FRAXtool ® identified 5% to 13% of patients at a high risk for fracture [ 49 ].…”

“…When applied to 238 patients enrolled in the Canadian Early Arthritis Cohort (CATCH) study without using BMD measurements, FRAXtool ® identified 5% to 13% of patients at a high risk for fracture [ 49 ]. Patients with a higher osteoporotic fracture risk determined by FRAXtool ® are more likely to be female, especially postmenopausal women, with alcohol use, glucocorticoid use, proton pump inhibitor use, and had lower BMI (<25 kg/m 2 ) [ 19 ]. High fracture risk patients identified by the FRAXtool ® was also statistically associated with disease duration, menopause duration, disease activity score (DAS28), and health assessment questionnaire (HAQ) [ 25 ].…”

“…During the last three decades, many studies have shown that besides the joint inflammation and destruction, bone mass in patients with rheumatoid arthritis (RA) is lower than in the matched non-RA population [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ] and the risk of osteoporosis is increased [ 8 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. Similarly, the incidence of osteoporotic fractures is high [ 6 , 11 , 12 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ] even when compared to the general population of the same age and sex [ 5 , 9 , 15 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ]. Osteoporosis-related fragility fractures represent one of the most severe complications in RA patien...…”

Atherosclerosis in SLE: a potential role for serum parathormone levels

“…15 A growing body of evidence over the last years revealed an excessive burden of both CVD and impaired bone health in patients with systemic autoimmune disorders. [16][17][18] For instance, in SLE, heightened rates of both subclinical atherosclerosis, 16 osteoporosis as well as peripheral and vertebral fractures have been repeatedly reported. 19 20 Moreover, low 25-OHD levels (<20 ng/mL) were found to be prevalent in patients with SLE .…”

Possibilities of using a FRAX® risk calculator for 10-year probability of fractures assessment in patients with rheumatoid arthritis

“…Возможность применения в клинической практике FRAX ® без введения дополнительной информации о МПК подтверждают исследования, в которых в различных популяциях и на разных группах пациентов значения риска перелома, полученные с помощью данного инструмента с введением данных МПК и без них, хорошо коррелировали между собой [15][16][17][18]. Однако определение риска перелома без МПК дает более высокий результат, чем его вычисление с учетом данных денситометрии шейки бедра как в популяции, так и среди больных РА, что может приводить к завышенной оценке риска перелома у конкретного пациента [19][20][21][22]. Так, например, в когорте 50 датских женщин с РА (средний возраст -63,6±11,7 года) добавление величины Т-критерия шейки бедренной кости уменьшило средние значения 10-летнего абсолютного риска перелома с 25,8±18,6 до 22,9±15,8% [19].…”