Background Rheumatoid arthritis (RA) is one cause of secondary osteoporosis. Multifactorial osteoporosis can be due to the disease itself, a decrease in physical activity, or treatment with glucocorticoids, but it can also have a postmenopausal cause. Accelerated generalized bone loss often leads to an increased risk of vertebral fractures.
Objectives To determine the prevalence and the risk factors for vertebral fractures in patients with RA.
Methods We started a 10-year prospective cohort study named TOMORROW (TOtal Management Of Risk factors in Rheumatoid arthritis patients to lOWer morbidity and mortality, clinical trial registration number: UMIN000003876) in 2010. This study included 208 patients with RA (biological agents, n=112; conventional therapy, n=96) and 205 age- and sex-matched volunteers (total, n=413). We evaluated the prevalence of vertebral fractures using thoracolumbar spine X-rays and analyzed the factors associated with vertebral fractures.
Results The prevalence of vertebral fractures was 45.5% and 30% in the RA and volunteer groups, respectively. Significantly more patients than volunteers had semiquantitative (SQ) grade 2 or more (15.2% vs. 5%). Bone mineral density, urine pentosidine, homocysteine and bone specific alkaline phosphatase (BAP) significantly correlated with vertebral fractures among the patients and urinary pentosidine values were significantly higher in the RA patients with fractures.
Conclusions The incidence of vertebral fractures was higher in patients with RA than in volunteers. Bone quality markers and vertebral fractures are closely linked with RA. We will continue to prospectively investigate the incidence of new vertebral fractures and the progression of osteoporosis in patients with RA.
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Disclosure of Interest T. Okano: None Declared, T. Koike Grant/Research support from: Takeda Pharmaceutical, Mitsubishi Tanabe Pharma Corporation, Chugai Pharmaceutical, Eisai, Abbott Japan, Teijin Pharma, Banyu Pharmaceutical and Ono Pharmaceutical, M. Tada: None Declared, Y. Sugioka: None Declared, K. Mamoto: None Declared, S. Wakitani: None Declared, H. Nakamura Grant/Research support from: Takeda Pharmaceutical, Mitsubishi Tanabe Pharma Corporation, Chugai Pharmaceutical, Eisai, Abbott Japan, Teijin Pharma, Banyu Pharmaceutical and Ono Pharmaceutical, Speakers Bureau: Ono Pharmaceutical