Background It’s widely known that the patients with rheumatoid arthritis (RA) have an increased risk of fragility fractures.
Objectives The aim of our study was to assess the absolute risk of osteoporotic fractures in the patients with RA by FRAX (Fracture risk assessment tool), to distribute them in the groups of high, middle and low fracture risk and then to compare. This allowed to characterize a group of patients with increased risk of fractures.
Methods 611 women aged 40 years and elder with RA from 834 women in clinical database of Institute of Rheumatology (Moscow) were included in the study. The fracture risk by FRAX was assessed without BMD results. We used the NOGG guidelines and management algorithm for the assessment of individuals at fracture risk. Also for the distribution of patients into risk groups, we used the management chart for osteoporosis (WHO), which shows the dependence of fracture risk by age and rateof FRAX.
Results The majority of the women with RA had high or middle fracture risk (58,6%). They were older (61,3 and 60,3 years) compared with patients at low fracture risk (mean age was 54,2 years). Among patients at low fracture risk there were more individuals with increased body mass index (BMI) and obesity (p<0,05). More women at high fracture risk reached menopause than in other groups (p<0,05). RA in the majority of these women (63,0%) began after menopause, while in 54.9% of women at low fracture risk RA started before menopause (p<0,001). Duration of the disease did not significantly differ between the groups. Although in all groups was dominated by patients with moderate disease activity and functional impairments, the number of patients with high disease activity and functional impairments was higher in groups with high and middle fracture risk (p<0,05) and the duration of glucocorticoid (GC) therapy was significantly longer in these groups (p<0,05). In 93,4%, 11,6% and 2,4% of our patients (in groups at high, middle and low fracture risk respectively) had a prior nontraumatic fractures.
Conclusions The majority of patients with RA had increased fracture risk. They were older, had a lower BMI. Almost all of them have reached menopause, and RA began after it happened. In groups with high and middle fracture risk the number of patients with high disease activity and functional impairments was higher and they received GC therapy for longer. They were also more likely to have any prior fractures history.
Kanis JA et al. Osteoporos Int 2010;21(2):S407-S413
Disclosure of Interest None Declared