Background Osteoporosis (OP) and falls lead to fractures especially in patients with rheumatoid arthritis (RA) due to pain and joint abnormalities, low muscle mass and strength, functional impairment, that have consequences on disease mortality and morbidity.
Objectives To determine the frequency of OP, sarcopenia, falls and fractures in RA patients during the prospective observational study.
Methods 133 patients (94% women; mean age, mean age 61±11) with RA from outpatient clinic were enrolled in the study in 2010-2011. All participants self-reported whether or not they had falls and a fracture event within the past 12 months. They completed risk factors questionnaire, Health Assessment Questionnaire (HAQ) and performed Short Physical Performance Battery (SPPB). Disease activity and intensity of pain were assessed with DAS28 and VAS. Bone density (BMD), total body composition, lean mass and fat mass, and fat free mass index were measured by dual energy X-ray absorptiometry (Hologic Discovery A). The presence of sarcopenia, sarcopenic obesity or overfat was established in 62 subjects according to Janssen I (1). Patients were followed up every 12 months during 3 years by telephone contact.
Results During a mean duration of 2.6 years, 49 patients (37%) reported a total of 84 falls with an incidence rate of 35/100 person-years. RA fallers did not differ from non-fallers in age, disease duration, performing SPPB test and handgrip strength, swollen and tender lower limb, visual acuity. RA fallers had significantly higher DAS28, HAQ, they received higher daily dose of glucocorticosteroids on baseline visit than non-fallers. A history of falls in the previous one year was a strong medical fall predictor with OR=2.9 [95%CI 1.28;6.52, p=0.005]. Low BMD was found out in 61 (46%) subjects, 29 (22%) received OP treatment, 65 (49%) – calcium and vitamin D supplements. RA fallers less consumed supplements of vitamin D (p<0.05). Sarcopenia was found in 50%, sarcopenic obesity – in 10%, overfat – in 13% of examed patients with RA. The presence of sarcopenia increased risk of fall in 3.17 times [95%CI 1.28;7.9, p=0.005]. 12 RA patients had 15 fractures: 2 spontaneous (vertebral) and 13 – due to fall: hip – 3, wrist – 4, ankle – 3, elbow – 2, vertebral – 1. 9 (75%) patients with fracture had OP, 6 (50%) – had fractures in the past, 75% – had FRAX high fracture risk, at the same time only 2 subjects received OP treatment, and 3 – supplements of calcium and vitamin D.
Conclusions Every second RA adult had OP and sarcopenia, every third - fall, and in one of the four fallen fracture occurred. It is necessary to consider RA patients as candidates for earlier preventing fractures programs including prophylaxis of OP and muscle weakness.
Janssen I, Baumgartner RN, Ross R, et al. Skeletal muscle cutpoints assosiated with elevated physical disability risk in older men and women. Am J Epidemiol 2004;159:413-21.
Disclosure of Interest None declared