Curtis J R, Arora T, Donaldson M, Alarcón G S, Callahan L F, Moreland L W, Bridges S L, Mikuls T R
University of Alabama at Birmingham, AL, USA.
Arthritis Rheum. 2009 Oct 15;61(10):1379-86. doi: 10.1002/art.24841.
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.
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.
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 > or =70 years of age with BMI > or =30 kg/m2.
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.
患有类风湿性关节炎（RA）的非裔美国人骨折风险可能会增加。我们将世界卫生组织（WHO）骨折风险评估工具（FRAX）和美国国家骨质疏松基金会（NOF）指南应用于一组患有早期RA的非裔美国人，以确定哪些患者被推荐进行骨质疏松症治疗。
对一组患有RA的非裔美国人评估风险因素和骨密度（BMD）。WHO FRAX工具估算10年骨折风险。使用不考虑BMD的FRAX对患者进行风险分层，以确定哪些个体可能最适合进行BMD检测。
参与者（n = 324）的平均年龄为51岁，其中81%为女性。RA疾病特征与BMD之间无关联。根据年龄和体重指数（BMI），被推荐进行骨质疏松症治疗的患者比例在3%至86%之间。仅用BMI计算的10年骨折风险通常与用BMD计算的骨折风险相同或更高；对于BMI低/正常的55至69岁患者以及BMI≥30 kg/m²的≥70岁患者，添加BMD数据为风险评估提供了最大的增加值。
根据2008年NOF指南，很大一部分患有RA的非裔美国人被推荐接受治疗。不考虑BMD的FRAX能够准确识别低风险患者。将FRAX系统应用于筛查RA患者等高风险群体，可用于确定进行BMD检测的个体，减少不必要检测和治疗的使用。
