medwireNews: Patients with rheumatoid arthritis (RA) who have high cumulative disease activity and functional disability have an elevated 10-year risk for osteoporotic fracture, researchers report.
Among 232 patients from the Siriraj RA Cohort, 18% had a high 10-year probability of experiencing a major osteoporotic fracture of the hip, spine, forearm, or humerus – defined as a score of more than 20% on the FRAX tool – while 25% were at moderate risk and 57% at low risk, defined as a FRAX score of 10–20% and less than 10%, respectively.
Patients in the highest risk group for osteoporotic fracture had the highest cumulative disease activity, followed by those in the moderate and low risk groups, with corresponding time-adjusted mean Disease Activity Score at 28 joints (DAS28) of 3.74, 3.45, and 3.31 points.
Moreover, patients at greater fracture risk had more severe cumulative functional disability; time-adjusted mean health assessment questionnaire scores were 1.33, 0.68, and 0.42 points in the high, moderate, and low fracture risk categories, respectively.
Wanruchada Katchamart (Mahidol University, Bangkok, Thailand) and study co-authors also identified a significant positive association between RA disease duration and osteoporotic fracture risk, and among the 177 participants who were menopausal women, those with the longest duration of menopause had the highest fracture risk.
When the authors restricted their analysis to hip fracture only, they found that 15% of patients had a high 10-year probability for hip fracture (FRAX score>10%), 34% had a moderate risk (FRAX score=3–10%), and 51% were at low risk (FRAX score<3%). In accordance with the results for major osteoporotic fracture risk, cumulative disease activity, cumulative functional disability, disease duration, and menopause duration were all positively associated with 10-year hip fracture risk.
Together, these findings indicate that “[m]oderate to high 10-year probabilities of major osteoporotic and hip fractures are common in RA,” and that those with more severe disease have the highest fracture risk, write the researchers in Clinical Rheumatology.
“Consequently, an osteoporotic fracture risk assessment and a tight control strategy aiming at low disease activity or remission should be routinely performed to reduce future osteoporotic fractures,” they conclude.
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