Background Osteoporosis is a major cause of morbidity in patients with RA. It leads to fragility fractures frequently associated with disability, mortality and major financial and social impact . There is no clear guidance regarding when to screen for Osteoporosis in these group of patients who are at high risk compared to general population. In our institute we assess the risk using Fracture Risk Assessment Tool (FRAX) and request DEXA scan to those who are at high risk as suggested by National Osteoporosis Guidance Group (NOGG) [2,3]. Osteoporosis is defined as bone mineral density of <-2.5 as per the WHO classification .
Objectives Our objective was to look at prevalence of Osteoporosis in our cohort of patients with RA and to identify factors associated with higher risk for Osteoporosis.
Methods Data was collected retrospectively using a standardized data collection tool for all the 230 patients who attended the multidisciplinary annual review clinic between Aug 2006 to Aug 2011. Multi nominal Logistic regression analysis was carried to see statistical significance of individual risk factors.
Results The demographic characteristics of patients in our cohort in showed in the table 1.
Out of 230 patients, 152 patients had DEXA scan. 52(23%) patients were already on osteoporosis treatment. Among 101 remaining patients 22(22%) were found to have osteoporosis. Multi nominal Logistic regression analysis shows none of the factors in isolation to be significantly associated with the T-scores <-2.5.
Characteristics of patients on osteoporosis treatment or have undergone DEXA Scanning results is as shown in table 2.
Conclusions In this large retrospective study we found that total of 45% of patients with RA were osteoporotic. This demonstrates importance of screening for osteoporosis in this group of patients as part of annual review. Our study did not show significant correlation between variables associated with patient demographics, disease duration, severity of RA as assessed based on seropositivity, extraarticular features, warranting biologics and osteoporosis. We suggest further research is required into development of composite scores or assays that could predict osteoporosis risk reliably so that DEXA scanning can be more focused.
British Society for Rheumatology and British Health Professionals in Rheumatology guideline for the management of rheumatoid arthritis (after the first 2 years)
WHO Scientific Group on the Assessment of Osteoporosis at primary Health care level Summary Meeting Report, Brussels, Belgium, 5-7 May 2004
Disclosure of Interest None Declared