Rheumatology Department, Cochin Hospital, Paris-Descartes University, Paris, France.
Osteoporos Int. 2012 Feb;23(2):581-7. doi: 10.1007/s00198-011-1584-3. Epub 2011 Feb 25.
Vertebral fracture assessment (VFA) is a convenient tool for the diagnosis of vertebral fracture in RA. Optimal control of inflammation may be an effective means to protect against vertebral fractures.
The aim of this case-control study was to assess the prevalence of vertebral fractures (VFs) in patients with RA using VFA technology.
Consecutive women (N = 101, 56.1 ± 14.2 years) with RA (mean disease duration, 14.9 ± 10 years) were recruited in the study. Clinical and biological statuses and treatments including glucocorticoids were assessed. Controls (N = 303), randomly selected from the general population, were individually matched to each case for age.
The prevalences of osteoporosis were 55.4% and 10.5% in patients and controls, respectively. Among the subjects, 21.7% and 4.2% had a vertebral fracture in the RA and control groups, respectively. Compared with controls, patients with RA had an increased risk of VFs: odds ratio (OR) (CI 95%) adjusted on body mass index was 6.5 (3.1, 13.9). In a multiple logistic regression analysis, VFs were independently associated with presence of non-vertebral fractures (OR = 9.2 [2.5-33.5]), presence of a fall in the previous year (OR = 4.6 [1.2-18.3]), current use of disease-modifying anti-rheumatic drugs (DMARDs) (OR = 0.05 [0.004, 0.51]) and current use of steroids (OR = 0.17 [0.04, 0.67]).
Rheumatoid arthritis is a risk factor of VF (OR = 6.5). VFA is a convenient tool for this diagnosis. Presence of VF is inversely related to the use of DMARD and glucocorticoids, enhancing the hypothesis that an appropriate control of the disease may be a protective factor against bone fragility.
椎体骨折评估（VFA）是诊断类风湿关节炎（RA）患者椎体骨折的一种便捷工具。最佳的炎症控制可能是预防椎体骨折的有效手段。
本病例对照研究旨在使用 VFA 技术评估 RA 患者的椎体骨折（VFs）患病率。
连续纳入 101 例女性（56.1±14.2 岁）RA 患者（平均病程 14.9±10 年），评估其临床和生物学状态以及包括糖皮质激素在内的治疗方法。对照组（N=303）为从一般人群中随机选择的个体，与每位病例按年龄进行一对一匹配。
患者和对照组的骨质疏松患病率分别为 55.4%和 10.5%。在研究对象中，RA 组和对照组的椎体骨折患病率分别为 21.7%和 4.2%。与对照组相比，RA 患者 VFs 的风险增加：经体质指数调整后的优势比（OR）（95%置信区间）为 6.5（3.1，13.9）。在多因素逻辑回归分析中，VFs 与非椎体骨折的存在（OR=9.2 [2.5-33.5]）、前一年跌倒（OR=4.6 [1.2-18.3]）、当前使用疾病修饰抗风湿药物（DMARDs）（OR=0.05 [0.004，0.51]）和当前使用类固醇（OR=0.17 [0.04，0.67]）独立相关。
类风湿关节炎是 VF 的危险因素（OR=6.5）。VFA 是诊断该病的一种便捷工具。VFs 的存在与 DMARD 和糖皮质激素的使用呈负相关，这进一步支持了适当控制疾病可能是预防骨脆弱的保护因素这一假说。
