Prevalence of silent nontraumatic vertebral fracture in rheumatoid arthritis: relation with disease duration, disease activity, corticosteroid, and hip buckling ratio

Mohamed M El-Wakd,Omar H Omar,Hala Abou Senna

doi:10.4103/1110-161x.140527

Mohamed M El-Wakd, Omar H Omar + Show 1 more

Open Access

https://doi.org/10.4103/1110-161x.140527

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Abstract

ObjectivesTo detect the prevalence of silent nontraumatic vertebral fractures (VFs) in patients with rheumatoid arthritis (RA) and its relation with disease duration, disease activity, corticosteroid (CS), and hip buckling ratio (BR).Patients and methodsThis cross-sectional study included a total of 150 RA patients. Disease activity was assessed using Disease Activity Score-28 (DAS-28). Dual-energy x-ray absorptiometry (DXA) was used to detect bone mineral density (B MD), VFs by vertebral fracture assessment (VFA), and hip BR by hip structural analysis program.ResultsA total of 17 (11.33%) RA patients had 27 silent VFs. Of the 17 VFs patients, 11 and six patients had single and multiple VFs, respectively. Of the 27 VFs, nine and 18 VFs had mild and moderate degree of VF. VF cases were significantly older in age (P = 0.001), had longer disease duration (P < 0.001), more active DAS-28 (P < 0.001), more cumulative CS dose, decreased spinal BMD (P = 0.02), and increased BR (P = 0.001). There were statistically significant relation between VFs and disease duration, DAS-28 and BR (P < 0.001 for all). VFs were independently associated with increased cumulative CS dose, high disease duration, and increased DAS-28 score (P < 0.001).ConclusionVFA-DXA should be performed on all RA patients. VF cases were significantly older in age, had long-standing disease duration, increased disease activity, reduced spinal BMD, increased cumulative CS dose, and increased BR. VFs were significantly related to increased disease duration, increased disease activity score, and increased BR of more than 10.

Highlights

Rheumatoid arthritis (RA) is a chronic systemic polyarticular inflammatory disease that involves joints and affects several organs, and is associated with excessive disability, mortality, and morbidity [1]
Vertebral fractures (VFs) cases were significantly older in age (P = 0.001), had longer disease duration (P < 0.001), more active Disease Activity Score-28 (DAS-28) (P < 0.001), more cumulative CS dose, decreased spinal bone mineral density (BMD) (P = 0.02), and increased buckling ratio (BR) (P = 0.001)
VF cases were significantly older in age, had long-standing disease duration, increased disease activity, reduced spinal BMD, increased cumulative CS dose, and increased BR

Summary

Introduction

Rheumatoid arthritis (RA) is a chronic systemic polyarticular inflammatory disease that involves joints and affects several organs, and is associated with excessive disability, mortality, and morbidity [1]. RA has an increased risk of osteopenia and osteoporosis (OP) [2], which are usually complicated by fragility fractures [3] found in the areas characterized by large amounts of trabecular bone, such as the vertebrae [4]. Vertebral fractures (VFs) usually occur without a definite trauma [5], and about one-third is clinically obvious [6]. CS is known to uncouple bone formation and resorption leading to OP [13]. It decreases the intestinal absorption and increases the renal excretion of calcium. The effects of CS depend on the duration and dose of therapy [10]

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