Background Rheumatoid arthritis (RA) is a systemic inflammatory disease and is commonly associated with osteoporosis. To prevent osteoporotic fractures in patients with RA, it is important to identify the high risk groups with a low bone mineral density (BMD) as well as other clinical risk factors and to apply an early pharmacological intervention for osteoporosis. The standard of pharmacological intervention for osteoporosis in patients with RA is based on the T-score measured by dual-energy X-ray absorptiometry (DEXA) similar to the general population. However, it may not be the proper standard to measure the high-risk group of patients with RA. To overcome the limitations of T-score, the fracture risk assessment tool (FRAX) was developed by the World Health Organization (WHO).
Objectives To identify patients without osteoporosis who met the criteria of the FRAX criteria of the National Osteoporosis Foundation (NOF) only and to compare patients who met only the FRAX criteria of the NOF and patients who presented osteoporosis in the incidence of fractures.
Methods Five hundred and forty five patients with rheumatoid arthritis who visited a single center were recruited in South Korea. The candidates for a pharmacological osteoporosis intervention were identified using the World Health Organization (WHO) criteria and the Korean FRAX model. In the follow-up period during median 30 months were investigated the new onset of fractures.
Results Of 223 patients who have no osteoporosis, 39 (17.4%) satisfied the FRAX criteria for pharmacological intervention. The discordance between the BMD and FRAX criteria for pharmacological intervention was remarkable in men, 11/29 (37.9%) vs. 19/29 (65.5%). During the follow up period occurred 2 new onset fractures in patients who met only the FRAX criteria and 22 new onset fractures in patients with osteoporosis by BMD. The incidence rate for new onset fractures of patients who met only the FRAX criteria was with 295.93 per 10,000 person-years higher than in the general population with 114.99 per 10,000 person-years.
Conclusions Patients who met the FRAX criteria of the NOF only need pharmacological intervention because their numbers of incidences for new onset fractures are similar to those of patients with osteoporosis by BMD.
Sinigaglia L, Nervetti A, Mela Q, Bianchi G, Del Puente A, Di Munno O et al. A multicenter cross sectional study on bone mineral density in rheumatoid arthritis. Italian Study Group on Bone Mass in Rheumatoid Arthritis. J Rheumatol 2000;27:2582-9.
van Staa TP, Geusens P, Bijlsma JW, Leufkens HG, Cooper C. Clinical assessment of long-term risk of fracture in patients with rheumatoid arthritis. Arthritis Rheum 2006;54:3104-12.
Kim SY, Schneeweiss S, Liu J, Daniel GW, Chang CL, Garneau K et al. Risk of osteoporotic fracture in a large population-based cohort of patients with rheumatoid arthritis. Arthritis Res Ther 2010;12:R154.
Baskan BM, Sivas F, Alemdaroglu E, Duran S, Ozoran K. Association of bone mineral density and vertebral deformity patients with rheumatoid arthritis. Rheumatol Int 2007;27:579-84.
Silverman SL. The clinical consequences of vertebral compression fracture. Bone 1992;13:S27–31.
Disclosure of Interest None declared
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.