Skeletal health among African Americans with recent‐onset rheumatoid arthritis

Abstract

Objective. African Americans with rheumatoid arthritis (RA) may be at increased fracture risk. We applied the World Health Organization (WHO) Fracture Risk Assessment Tool (FRAX) and National Osteoporosis Foundation (NOF) guidelines to a cohort of African Americans with early RA to identify which patients were recommended for osteoporosis treatment. Methods. Risk factors and bone mineral density (BMD) were assessed in a cohort of African Americans with RA. The WHO FRAX tool estimated 10-year fracture risk. Patients were risk stratified using FRAX without BMD to identify which individuals might be most efficiently targeted for BMD testing. Results. Participants (n ‫؍‬ 324) had a mean age of 51 years and included 81% women. There were no associations of RA disease characteristics with BMD. The proportion of patients recommended for osteoporosis treatment varied from 3-86%, depending on age and body mass index (BMI). Ten-year fracture risk calculated with BMI only was generally the same or higher than fracture risk calculated with BMD; adding BMD data provided the most incremental value to risk assessment in patients 55-69 years of age with low/normal BMI, and in those >70 years of age with BMI >30 kg/m 2 . Conclusion. A high proportion of African Americans with RA were recommended for treatment under the 2008 NOF guidelines. FRAX without BMD identified low-risk patients accurately. Systematic application of FRAX to screen high-risk groups such as patients with RA may be used to target individuals for BMD testing and reduce the use of unnecessary tests and treatments.

The Risk of Osteoporotic Fractures According to the FRAX Model in Korean Patients with Rheumatoid Arthritis

“…Also, several reports verified the use of the FRAX tool for patients with inflammatory arthritis (15, 17). This is the first study using the Korean FRAX model to evaluate the fracture risk in patients with RA.…”

Bone Mineral Density Changes in Patients with Recent-Onset Rheumatoid Arthritis

“…However, none of these findings reached statistical significance. Kim et al14 also observed an increased risk of osteoporosis associated with a positive RF and elevated acute phase reactants, although this was not statistically significant. While Solomon et al,21 have found that BMD at the total hip was significantly lower in rheumatoid factor-positive women than in rheumatoid factor-negative women.…”

“…Similarly, a study reported by Kim et al13 showed an increased risk of osteoporotic fractures in RA patients in all age groups, regardless of gender, and at various anatomical sites compared with individuals without RA. In contrast, Curtis et al14 found that the proportion of their RA patients meeting t score criteria for osteoporosis (t score ≤ −2.5 at either the lumbar spine or femoral neck) was only 4%, and Yoon et al15 reported that 52% of their patients with early-onset RA had osteoporosis and 39% were classified as having osteopenia.…”

“…This was in agreement with Brand et al,12 the DAS-28 score was not corrrelated with BMD. Similarly, Curtis et al14 reported that there were no associations of RA activity, severity, or erosions with BMD at either site on univariate or multivariate analysis.…”

Population-Based Fracture Risk Assessment and Osteoporosis Treatment Disparities by Race and Gender

“…These results might be used as the first step in a two-step approach to identify persons at higher fracture risk on the basis of clinical risk factors; these individuals would therefore be more efficiently targeted for additional osteoporosis evaluation, including DXA testing. Indeed, we have recently demonstrated in a small cohort of 324 high-risk patients that FRAX without BMD provides a sensitive screening test, and the second step (incorporating DXA data) enhances specificity 24 . Our results are consistent with prior literature in more geographically restricted settings demonstrating that African Americans are less likely to be screened or treated for osteoporosis.…”