FRI0105 Low Thoracic Bone Mineral Density and Glucocorticoid Are Risk Factors for Clinical Fractures in Patients with Rheumatoid Arthritis: Five-Year Findings of The Tomorrow Study: Table 1.

Abstract Background/Aims Osteoporosis (OP) is an extra-articular manifestation of rheumatoid arthritis (RA) that leads to increased fracture susceptibility due to a variety of reasons including immobility and cytokine driven bone loss. Bone loss in other populations has well documented risk factors. It is unknown whether bone loss in RA predominantly affects the femoral neck or the spine. This study aimed to identify independent predictors of low bone mineral density (BMD) in patients RA at the lumbar spine and the femoral neck. Methods This was a retrospective observational cohort study using patients with Rheumatoid arthritis attending for a regional dual X-ray absorptiometry (DEXA) scan at the Royal Lancaster Infirmary between 2004 and 2014. BMD in L1-L4 in the spine and in the femoral neck were recorded. The risk factors investigated were steroid use, family history of osteoporosis, smoking, alcohol abuse, BMI, gender, previous fragility fracture, number of FRAX(tm) risk factors and age. Univariate and Multivariate regression analysis models were fitted to explore bone loss at these sites using BMD in g/cm2 as a dependant variable. . Results 1,527 patients were included in the analysis, 1,207 (79%) were female. Mean age was 64.34 years (SD11.6). mean BMI was 27.32kg/cm2 (SD 5.570) 858 (56.2%) had some steroid exposure . 169(11.1%) had family history of osteoporosis. fragility fracture history found in 406 (26.6%). 621 (40.7%) were current or ex smokers . There was a median of 3 OP risk factors (IQR 1,3) The performance of the models is shown in table one below. Different risk factors appeared to influence the BMD at different sites and the cumulative risk factors influenced BMD in the spine. None of the traditional risk factors predicted poor bone loss well in this cohort. P129 Table 1:result of the regression modelsCharacteristicB femoral neck95% CIpB spine95%CIpAge at scan-0.004-0.005,-0.003<0.01-0.0005-0.002,0.00050.292Sex-0.094-0.113,-0.075<0.01-0.101-0.129,-0.072<0.01BMI (mg/m2)0.0080.008,0.0101<0.010.01130.019,0.013<0.01Fragility fracture-0.024-0.055,0.0060.12-0.0138-0.060,0.0320.559Smoking0.007-0.022,0.0350.650.0286-0.015,0.0720.20Alcohol0.011-0.033,0.0 5560.620.0544-0.013,0.1120.11Family history of OP0.012-0.021,0.0450.470.0158-0.034,0.0650.53Number of risk factors-0.015-0.039,0.0080.21-0.039-0.075,-0.0030.03steroids0.004-0.023,0.0320.030.027-0.015,0.0690.21 Conclusion This study has shown that predictors of low BMD in the spine and hip are different and less influential than expected in this cohort with RA . As the FRAX(tm) tool only uses the femoral neck, this might underestimate the fracture risk in this population. Further work looking at individual areas is ongoing. Disclosure M.A. Swar: None. M. Bukhari: None.

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Risk Factors for Systemic Reduced Bone Mineral Density in Premenopausal Female Patients with Early Untreated Rheumatoid Arthritis

Aktuelle Rheumatologie ◽

10.1055/a-0591-2364 ◽

2018 ◽

Vol 45 (04) ◽

pp. 334-340

Author(s):

Hamada S. Ahmed ◽

Sherif E. Farrag ◽

Amr E. Okasha ◽

Gamal Othman ◽

Ibrahim Shady

Keyword(s):

Rheumatoid Arthritis ◽

Risk Factors ◽

Bone Mineral Density ◽

Rheumatoid Factor ◽

Bone Mineral ◽

Early Rheumatoid Arthritis ◽

Mineral Density ◽

T Score ◽

Increased Risk ◽

Treatment Naïve

Abstract Background Systemic osteoporosis (OP) is evident among patients with early rheumatoid arthritis (ERA). This study aimed to investigate the OP risk factors in patients with ERA and who was treatment-naïve at inclusion. Subjects and Methods Systemic bone mineral density (BMD) of the lumbar spine (LS), femoral neck (FN) and total hip (TH) was measured in 135 treatment-naïve premenopausal females with early Rheumatoid Arthritis (ERA). For all patients, demographic data, vitamin D status, and the specific parameters of the disease, including disease activity, serum levels of rheumatoid factor and anti-citrullinated protein antibodies (ACPA) were evaluated. Results T score was<−1.0 in the LS in 16.2%, in the FN in 22.2% and in the TH in 23.7%. Among our patients, 29.6% had below normal T score at any site. Demographic characteristics, RA duration, diseases activity did not significantly impact BMD. However, patients with decreased BMD were more prevalent ACPA- and rheumatoid factor (RF)-positive than patients with normal BMD. Also, high titer ACPA or RF is associated with more marked reduction in BMD. In regression analysis, after adjustment for possible confounders, patient stratification according to ACPA status and RF status (into negative, low-positive and high positive) still a significant independent variable associated with lower BMD values. Conclusion Presence of ACPA or RF is associated with increased risk for development of reduced systemic BMD from very early stage of rheumatoid arthritis. Furthermore, this risk increases more with higher levels of ACPA or RF. Measurement of BMD should be performed for ACPA- or RF-positive patients with early RA.

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