Prevalence and risk factors associated with vertebral osteoporotic fractures in patients with rheumatoid arthritis

Rheumatoid arthritis and osteoporosis: a bi-directional Mendelian randomization study

“…Previous observation studies have shown powerful evidence of an association between active RA and low BMD [ 27 – 30 ]. According to a population-based study, the prevalence of OP had a twofold increase in both male and female RA patients compared with healthy subjects [ 31 ]. A Korean cohort including 47,034 RA patients and 235,170 controls also indicated an increased risk of osteoporotic fractures for RA patients across all sexes, age groups, and various anatomic sites, compared with non-RA patients [ 32 ].…”

Osteoporosis in Rheumatoid Arthritis: Dangerous Liaisons

“…Other risk factors that can account for OP in RA include systemic inflammation associated with disease activity, local effect of immune cells leading to bone erosions, glucocorticoid (GC) therapy and impairment of physical activity (14). Therefore, OP and fractures are more frequent in patients with high disease activity (according to DAS28), presence of periarticular bone erosions and cumulative structural damage, RA disease duration ≥ 10 years, high HAQ score or high titers of anti-citrullinated protein antibodies (ACPA) and rheumatoid factor (RF) positivity (6,9,10,(14)(15)(16). In one study, vertebral fracture risk in RA patients was related to longer disease duration, dose and duration Abbreviations: ACPA, anti-citrullinated protein antibodies; ACR, American College of Rheumatology; Anti-CarPA, anti-carbamylated protein antibodies; BMD, bone mineral density; BMI, body mass index; CI, confidence interval; CTX-I, carboxy-terminal telopeptide of type 1 collagen; CXCL8, C-X-C motif chemokine ligand 8; DAS28, disease activity score counted over 28 joints; DDK-1, Dickkopf-1 protein; DMARD(s), disease modifying anti-rheumatic drug(s); DXA, dual X-ray densitometry; DXR, dual X-ray radiogrammetry; EULAR, European league against Rheumatism; FRAX, fracture risk assessment tool; GC(s), glucocorticoid(s); HAQ, health assessment questionnaire; hTNF-tg, human tumor necrosis factor transgenic; Ig, immunoglobulins; IL, interleukin; IFN-, interferon gamma; M-CSF, macrophage colony-stimulating factor; OP, osteoporosis; OPG, osteoprotegerin; PEARL, Princesa early arthritis register longitudinal; PINP, procollagen type 1 N-terminal propeptide; RA, rheumatoid arthritis; RANK/RANK-L, receptor activator of nuclear factor (NF)-kB (RANK) and its ligand; RF, rheumatoid factor; TNF-α, tumor necrosis factor; TNFi, TNF-α inhibitors; Th, T helper lymphocytes; Treg, regulatory T cells; uNTx, cross-linked N-telopeptide of type I collagen; Wnt, drosophila segment polarity gene wingless and integrated or int-1 of the vertebrate homolog.…”

“…In one study, vertebral fracture risk in RA patients was related to longer disease duration, dose and duration Abbreviations: ACPA, anti-citrullinated protein antibodies; ACR, American College of Rheumatology; Anti-CarPA, anti-carbamylated protein antibodies; BMD, bone mineral density; BMI, body mass index; CI, confidence interval; CTX-I, carboxy-terminal telopeptide of type 1 collagen; CXCL8, C-X-C motif chemokine ligand 8; DAS28, disease activity score counted over 28 joints; DDK-1, Dickkopf-1 protein; DMARD(s), disease modifying anti-rheumatic drug(s); DXA, dual X-ray densitometry; DXR, dual X-ray radiogrammetry; EULAR, European league against Rheumatism; FRAX, fracture risk assessment tool; GC(s), glucocorticoid(s); HAQ, health assessment questionnaire; hTNF-tg, human tumor necrosis factor transgenic; Ig, immunoglobulins; IL, interleukin; IFN-, interferon gamma; M-CSF, macrophage colony-stimulating factor; OP, osteoporosis; OPG, osteoprotegerin; PEARL, Princesa early arthritis register longitudinal; PINP, procollagen type 1 N-terminal propeptide; RA, rheumatoid arthritis; RANK/RANK-L, receptor activator of nuclear factor (NF)-kB (RANK) and its ligand; RF, rheumatoid factor; TNF-α, tumor necrosis factor; TNFi, TNF-α inhibitors; Th, T helper lymphocytes; Treg, regulatory T cells; uNTx, cross-linked N-telopeptide of type I collagen; Wnt, drosophila segment polarity gene wingless and integrated or int-1 of the vertebrate homolog. of GC treatment, higher HAQ, Sharp score (cumulative structural damage), ACPA and older age (10). Indeed, ACPA positivity is independently associated with severe trabecular bone loss (13).…”

“…Therefore, low doses of GCs could provide protection from inflammatory bone loss during polyarthritis flares and might counteract their unfavorable effects on bone resorption leading to neutral or even positive net skeletal balance (20,21). The cumulative GC dose (long-term or high dose) as well as the continuous vs. alternative GC dosage strategy are correlated with an increased risk of fracture or a reduced BMD in juxta-articular bone, spine and femoral neck (10,14,22,23). In addition, GCs induce muscle wasting which secondarily increases the risk of falls and fractures (20).…”

“…In a meta-analysis, the incidence of fragility fractures in RA and general population were 33.00 and 15.31 per 1,000 person-years, respectively (9). The spine is often the most commonly affected site and the incidence of vertebral fractures in RA might be up to 5 times the rate of healthy controls (9,10). Interestingly, the prevalence of osteopenia and osteoporosis in a large cohort of patients with RA using Vertebral Fracture Assessment (VFA) technique is around 40-60%, while the prevalence of vertebral fractures through VFA images in the same cohort was 13% (11).…”