The prevalence of vertebral fracture on vertebral fracture assessment imaging in a large cohort of patients with rheumatoid arthritis

Akheel, Mohammad; Lohan, Derek G.; Bergin, Diane; Mooney, Sarah; Newell, John; O’Donnell, Martin; Coughlan, Robert J.; Carey, John J.

doi:10.1093/rheumatology/ket353

Cited by 53 publications

(44 citation statements)

References 36 publications

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“…Similarly to osteoporosis, the causes of the higher prevalence of fragility fracture in patients with long-term RA than in the general population are multifactorial. The prevalence of RA-associated fragility fracture is reportedly 13–27% [ 3 , 25 , 26 ]. The rate of previous fracture, as defined by the FRAX® tool, in our series was 18.6%.…”

Section: Discussionmentioning

confidence: 99%

Anti-CCP-positive patients with RA have a higher 10-year probability of fracture evaluated by FRAX®: a registry study of RA with osteoporosis/fracture

Cheng

et al. 2018

Arthritis Res Ther

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BackgroundPositive anticyclic citrullinated peptide (anti-CCP+) is associated with bone loss in patients with rheumatoid arthritis (RA). However, whether overall positivity or specific levels of anti-CCP are associated with prevalent fracture or a 10-year probability of fracture remains unclear.MethodsThis interim analysis of an RA registry was conducted at Chang Gung Memorial Hospital in Kaohsiung (CGMHK) for RA-related osteoporosis/fracture. Consecutive patients with RA who had visited the rheumatology clinic at CGMHK since September 1, 2014, and fulfilled the classification criteria of RA were enrolled. The demographics, disease duration, Disease activity in 28 joints based on erythrocyte sedimentation rate (DAS28-ESR), lifestyle, evidence of previous fracture, risk factors of fracture in the Fracture Risk Assessment Tool (FRAX®), and FRAX® score of each participant were collected. Anti-CCP, rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and bone mineral density (BMD) were measured at enrollment. The patients were grouped by positivity or quartiles of anti-CCP level (I–IV).ResultsFive hundred twenty-one patients with RA were enrolled through May 31, 2016. In total, 359 (68.9%) patients were anti-CCP+. Compared with anti-CCP− patients, anti-CCP+ patients had a significantly higher DAS28-ESR (p = 0.0001) and 10-year probability of major (15.0 [18.9] vs. 12.0 [15.3], p = 0.0461) or hip (5.0 [9.2] vs. 3.6 [8.2], p = 0.0118) fracture, but a significantly lower BMD of the FN (p = 0.0196). The rates of osteoporosis and previous fracture were comparable. There were 130, 127, 132, and 132 patients in groups I–IV, respectively. The DAS28-ESR was significantly different (p = 0.0001) among the groups and correlated to anti-CCP levels. The BMD and 10-year probability of major (p = 0.0067) and hip (p = 0.0013) fracture among the groups were also different.ConclusionsAnti-CCP+ RA patients had a higher 10-year probability of major or hip fracture, independent of anti-CCP levels, and a lower BMD of the FN than anti-CCP− patients.

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Section: Discussionmentioning

confidence: 99%

Anti-CCP-positive patients with RA have a higher 10-year probability of fracture evaluated by FRAX®: a registry study of RA with osteoporosis/fracture

Cheng

et al. 2018

Arthritis Res Ther

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“…[ 5 , 6 ] The risk of VFs is higher in patients with RA than in those with primary osteoporosis. [ 7 , 8 ] BMD accounts for ∼70% of bone strength and is frequently used as a representative measure. [ 9 ] However, there is a discrepancy between low BMD and fracture risk, as many fractures are observed in RA patients who are not in the osteoporotic range.…”

Section: Introductionmentioning

confidence: 99%

Trabecular bone score as a supplementary tool for the discrimination of osteoporotic fractures in postmenopausal women with rheumatoid arthritis

Choi¹,

Chung²,

Suh³

et al. 2017

Medicine

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Rheumatoid arthritis (RA) is a risk factor for bone fragility, and its effect on fracture risk is independent of bone mineral density (BMD). The trabecular bone score (TBS) is a new indirect parameter of bone quality. In this study, BMD and the TBS were compared between female postmenopausal RA patients with and those without vertebral fractures (VFs).This study had a cross-sectional design. Two hundred seventy-nine postmenopausal women with RA aged 50 years or older were included in this study. TBS measurements were performed on the same vertebrae as those for the BMD measurements.Among the 279 subjects, 34 had VFs (12.5%). There was a significant difference in the TBS (P = .005) but not L-spine BMD (P = .142) between the subjects with and those without VFs. The odds ratio (OR) for the TBS per standard deviation decrease was significant, even after adjusting for confounding factors such as age, height, rheumatoid factor positivity, the disease activity score for 28 joints (DAS28), the cumulative dose of glucocorticoids (GCs), the time since menopause and osteoporosis drug use (OR = 2.86; 95% CI, 1.34–6.09), and L-spine BMD (OR = 2.57; 95% CI, 1.19–5.54). The TBS was negatively correlated with the cumulative dose of GCs, but not with the DAS28 or erythrocyte sedimentation rate. However, the correlation was an L-shaped nonlinear relationship.The TBS could be a supplementary tool for discriminating osteoporotic fractures in postmenopausal women with RA, and it may have a nonlinear relationship with the cumulative dose of GCs, but not with RA disease activity.

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“…Previous reports showed the prevalence of VF of 13% in RA patients of age more than 40 including both women and men (6), and that for women RA patients was higher as 21.7%-36% (15, 16). The prevalence of our study was slightly higher, but our study population was older than previous study.…”

Section: Discussionmentioning

confidence: 91%

“…Osteoporosis leading to bone fracture is one of the main co-morbidities of RA, and approximately one-third of women with RA report a fracture within 5 yr of follow-up (5). Recent study showed the prevalence of vertebral fracture (VF) in RA patients of age more than 40 yr including both women and men was 13% and it was increased to 65% in patients of age more than 50 (6). Several studies have shown that VF can affect the development of subsequent vertebral and non-vertebral fractures (7, 8, 9, 10, 11, 12), and patients with VF have higher mortality than patients without VF (13).…”

Section: Introductionmentioning

confidence: 99%

The Influence of Vertebral Fracture on the Functional Disability of Patients with Rheumatoid Arthritis

et al. 2014

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The aim of the present study was to identify the influence of vertebral fracture (VF) on the functional disability in patients with rheumatoid arthritis (RA). This study consecutively enrolled 100 female patients aged 50 yr or older with RA. All participants underwent lateral imaging of the thoracolumbar spine by simple radiography to identify any VFs. They also completed questionnaires via interview regarding demographics, medical history, and disease outcomes including functional disability. We used univariate analysis to evaluate associations between functional disability and VF, and made multivariate logistic regression models to test independent effect of the presence of VF, the number of VFs, and the severity of VF on functional disability. Among the 100 RA patients, 47 had at least one VF, but 34 of them were asymptomatic that they had experienced a fracture. The multiple VFs ≥ 3 (OR, 8.95; 95% CI, 1.77-44.15, P = 0.01) and moderate or severe VF (OR, 3.38; 95% CI, 1.26-9.04, P = 0.02) were related to disability in univariate analysis. The multiple VFs ≥ 3 (OR, 6.13; 95% CI, 1.02-36.94, P = 0.048) was associated with functional disability of RA patients after adjusting various confounders and it was mainly in walking and arising. The VF might be an important factor which affects functional disability in RA patients.Graphical Abstract

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The prevalence of vertebral fracture on vertebral fracture assessment imaging in a large cohort of patients with rheumatoid arthritis

Abstract: VFs were detected on VFA images in 13% of women and men with well-established RA referred for DXA testing. Longer duration and severity of RA disease were independent risk factors for fractures in our study.

Cited by 53 publications

References 36 publications

Anti-CCP-positive patients with RA have a higher 10-year probability of fracture evaluated by FRAX®: a registry study of RA with osteoporosis/fracture

Anti-CCP-positive patients with RA have a higher 10-year probability of fracture evaluated by FRAX®: a registry study of RA with osteoporosis/fracture

Trabecular bone score as a supplementary tool for the discrimination of osteoporotic fractures in postmenopausal women with rheumatoid arthritis

The Influence of Vertebral Fracture on the Functional Disability of Patients with Rheumatoid Arthritis

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