Background Rheumatoid arthritis (RA) is one cause of secondary osteoporosis . Multifactorial osteoporosis can be due to the disease itself, a decrease in physical activity, treatment with glucocorticoids, and being postmenopausal. Accelerated generalized bone loss often leads to increased risk of vertebral fractures . We started a prospective cohort study (TOtal Management Of Risk factors in Rheumatoid arthritis patients to lOWer morbidity and mortality: TOMORROW study, UMIN000003876) to compare risk factors for osteoporosis between patients with RA and controls.
Objectives We previously reported that the prevalence of vertebral fractures is significantly higher in patients with RA than controls. We compared the prevalence of new vertebral fractures and associated risk factors between patients with RA and controls based on the 5-year follow-up findings of the TOMORROW study.
Methods This study included 208 patients with RA (among whom 112 were medicated with biological agents and 96 received conventional therapy) and 205 age- and sex-matched healthy volunteers (n=413). Vertebral fractures evaluated using thoracolumbar spine X-rays, whole body bone mineral density (BMD) assessed using a QDR-4500 (Hologic, Marlborough, MA, USA) and bone metabolic markers were compared in 2010, 2011, and 2015. The prevalence of new vertebral fractures and associated risk factors were evaluated.
Results Thoracolumbar spine radiographs and clinical data were analyzed from 182 patients with RA and 190 controls. More new vertebral fractures were found in the patients than in the controls (26 [14.3%] vs. 14 [7.4%]; P=0.03) and they were likely to be more severe in the patients. The SQ grade was ≥2 in 53.8% and 42.9%, respectively, and more than one new vertebral fracture was found in 26.9% and 21.4%, respectively of the patients and controls. Logistic regression analysis of patients with RA selected previous vertebral fracture (adjusted OR, 7.88; 95% CI, 2.00–31.0), persistent low BMD (adjusted OR, 5.11; 95% CI, 1.13–23.1), glucocorticoid use (adjusted OR, 3.71; 95% CI, 1.14–12.0), and age (adjusted OR, 1.07; 95% CI, 1.01–1.14) as risk factors for new vertebral fractures.
Conclusions New vertebral fractures were significantly more frequent in patients with RA during follow-up for five years. Pre-existing vertebral fracture and persistent low BMD were risk factors for new vertebral fractures.
Gough AK, Lilley J, Eyre S, Holder RL, Emery P. Generalised bone loss in patients with early rheumatoid arthritis. Lancet. 1994;344:23–7.
Lodder MC, Haugeberg G, Lems WF, Uhlig T, Orstavik RE, Kostense PJ, et al. Radiographic damage associated with low bone mineral density and vertebral deformities in rheumatoid arthritis: the Oslo-Truro-Amsterdam (OSTRA) collaborative study. Arthritis Rheum. 2003;49:209–15.
Disclosure of Interest None declared