Risk factors associated with bone loss and occurrence of fragility fractures in rheumatoid arthritis patients

Aim of the work

To investigate the bone mineral density (BMD) in rheumatoid arthritis (RA) Tunisian patients, to identify the risk factors associated with its decrease and to assess the fracture risk.

Patients and methods

The study included 173 patients and 173 matched healthy controls. BMD was assessed by the dual-energy X-ray absorptiometry. The risk of hip fracture (HF) and major osteoporotic fracture (MOF) were assessed using the fracture risk assessment tool (FRAX). The disease activity, radiological severity and functional status were investigated.

Results

The mean age of patients was 54.1?±?11.04?years and 141 were females; 71.6% menopausal. Disease duration was 8.2?±?8?years and disease activity score was 5.54?±?1.26. Sharp van-der-Heijde (SvdH) score was 113.9?±?106.8, health assessment questionairre (HAQ) score 1.03?±?0.9. The BMD was significantly reduced in 138 (79.8%) patients and FRAX was higher compared to control (p?<?.001). The frequency of osteoporosis (48% vs. 18.5%), the risk of MOF (1.8?±?2.6 vs. 0.6?±?0.3) and HF (0.7?±?1.7 vs. 0.08?±?0.1) were significantly higher in RA patients than in controls. Bone loss in RA was significantly associated with age, low body mass index (BMI), longer disease duration, rheumatoid factor, SvdH, atlantoaxial subluxation and corticosteroids use. Menopause, low calcium intake, erythrocyte sedimentation rate and HAQ were risk factors for reduced BMD. The risk of MOF and HF was associated with age, menopause, calcium intake, BMI, disease duration, HAQ, SvdH, cumulative dose and duration of corticosteroids.

Conclusion

bone loss and fragility fracture are frequent in RA and related to disease severity, function impairment and corticosteroids use.