Prevalence and Fracture Risk of Osteoporosis in Patients with Rheumatoid Arthritis: A Multicenter Comparative Study of the FRAX and WHO Criteria.

Sang Choi,Seong-Ryul Kwon,Ju-Yang Jung,Ji-Min Kim,Ji-Ho Park,Hyoun-Ah Kim,Chang-Hee Suh,Sung-Soo Kim,Sang Kim

doi:10.3390/jcm7120507

Abstract

(1) Background: We evaluated the prevalence and fracture risk of osteoporosis in patients with rheumatoid arthritis (RA), and compared the fracture risk assessment tool (FRAX) criteria and bone mineral density (BMD) criteria established by the World Health Organization (WHO). (2) Methods: This retrospective cross-sectional study, which included 479 RA patients in 5 hospitals, was conducted between January 2012 and December 2016. The FRAX criteria for high-risk osteoporotic fractures were calculated including and excluding the BMD values, respectively. The definition of high risk for fracture by FRAX criteria and BMD criteria by WHO was 10-year probability of ≥ 20% for major osteoporotic fracture or ≥ 3% for hip fracture, and T score ≤ −2.5 or Z score ≤ −2.0, respectively. (3) Results: The mean age was 61.7 ± 11.9 years. The study included 426 female patients (88.9%), 353 (82.9%) of whom were postmenopausal. Osteoporotic fractures were detected in 81 (16.9%) patients. The numbers of candidates for pharmacological intervention using the FRAX criteria with and without BMD and the WHO criteria were 226 (47.2%), 292 (61%), and 160 (33.4%), respectively. Only 69.2%–77% of the patients in the high-risk group using the FRAX criteria were receiving osteoporosis treatments. The following were significant using the WHO criteria: female (OR 3.55, 95% CI 1.46–8.63), age (OR 1.1, 95% CI 1.08–1.13), and BMI (OR 0.8, 95% CI 0.75–0.87). Glucocorticoid dose (OR 1.09, 95% CI 1.01–1.17), age (OR 1.09, 95% CI 1.06–1.12), and disease duration (OR 1.01, 95% CI 1–1.01) were independent risk factors for fracture. (4) Conclusions: The proportion of RA patients with a high risk of osteoporotic fractures was 33.4%–61%. Only 69.2%–77% of candidate patients were receiving osteoporotic treatments while applying FRAX criteria. Independent risk factors for osteoporotic fractures in RA patients were age, the dose of glucocorticoid, and disease duration.

Highlights

Osteoporosis is one of the most well-known complications in patients with rheumatoid arthritis (RA)
The fracture risk assessment tool (FRAX) criteria and the bone mineral density (BMD) criteria established by the World Health Organization (WHO) are widely used for the risk assessment of osteoporotic fractures
FRAX, fracture risk assessment tool; BMD, bone mineral density; WHO, World Health Organization; OR, Odds Ratio; 95% CI, 95% confidence intervals; BMI, body mass index

Summary

Introduction

Osteoporosis is one of the most well-known complications in patients with rheumatoid arthritis (RA). The treatment with glucocorticoids increases the imbalance which already existed due to the disease. This association may be due to a lack of mobility and frequent occurrences of RA during menopause as well as systemic inflammation of RA and the use of corticosteroids [1,2,3]. The frequency of osteoporosis in patients with RA has been reported to be 6.3% to 36.3% in the hip, and 12.3% to 38.9% in the spine [4,5,6]. Hip and vertebral osteoporotic fractures are known to be associated with an immediate and long-term (up to 20 years) increased risk of mortality [8]. It is very important to accurately assess the risk of osteoporotic fractures in RA patients

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