Background:Rheumatoid arthritis (RA) is a chronic disabling disease that is associated with bone loss. Previous studies estimated that approximately one-third of the RA patients had osteoporosis (OP). However, most fragility fractures occur in patients not suffering from OP, that can be partly explained by impaired quality of bone, which is not measured with DXA. Therefore, only the measurement of bone mineral density is not sufficient to determine the indication for OP treatment. Another tool for assessing the need for anti-osteoporotic therapy is to calculate the 10-year probability of a major fracture using the fracture risk assessment tool (FRAX).Objectives:To assess the need for anti-osteoporotic therapy in women with rheumatoid arthritis (RA) based on the identification of individuals with fragility fractures and high risk of fracture according to FRAX.Methods:295 postmenopausal women with RA were included in the study. The average age was 63±7 years, the duration of RA was 11 [4;16] years, the duration of postmenopausal period was 13 [6; 20] years. 121 (41%) patients took glucocorticoids (cumulative dose 9025 [3650; 20720] mg in prednisolone equivalent). A survey was conducted to identify patients with risk factors and a history of fragility fractures. The 10-year probability of a major osteoporotic fracture was assessed using the FRAX tool. In patients treated with glucocorticoids at a dose >7.5 mg in prednisolone equivalent the estimates of probabilities of a major osteoporotic fracture were adjusted in accordance with the recommendations [1]. Dual-energy X-ray absorptiometry (DXA) of the proximal femur was performed in patients with a moderate risk (probabilities between the upper and lower assessment age-dependent intervention threshold) and the risk of fracture was recalculated with including femoral neck BMD.Results:83 (28.1%) patients had a prior fragility fracture: 44 (14,9%) – 1, 20 (6,8%) – 2 and 19 (6.4%) – 3 or more. Vertebral fractures were the most common, they accounted for 62,1% of all fractures, distal forearm was the second frequent fractures localization (18.2%). Only 2 (0.7%) women had hip fracture. The average 10-year probability of a major osteoporotic fracture was 17 % [11; 28] in RA women. 92 (31.2%) persons were at high risk, 28 (9.5%) patients - at low risk, and 175 (59.3%) - at moderate risk. After recalculation of fracture risk with including femoral neck BMD in people at moderate risk 48 (16.3 %) patients became at high risk, 9 (3.1%) – at very high risk, and 118 (40.0%) - at low risk.Thus, 149 (50.5%) RA patients were at very high or high risk and 146 (49,5%) – at low risk of major osteoporotic fracture according to FRAX, among the last – only 3 persons had a history of fragility fracture after age of 40 years.Conclusion:Our study demonstrated that a half of postmenopausal women with RA had indications for anti-osteoporotic treatment based on the results of a 10-year probability of major fragility fractures using FRAX tool.References:[1]Kanis JA, Johansson H, Oden A, McCloskey EV. Guidance for the adjustment of FRAX according to the dose of glucocorticoids. Osteoporos Int. 2011;22(3):809-816. doi:10.1007/s00198-010-1524-7.Disclosure of Interests:None declared
Relationship Between Obesity and Risk of Major Osteoporotic Fracture in Postmenopausal Women: Taking Frailty Into Consideration