Department of Rheumatology, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain.
Departament of Internal Medicine, University Hospital Marqués de Valdecilla-IDIVAL, Universidad de Cantabria, Santander, Spain.
Osteoporos Int. 2021 Jul;32(7):1333-1342. doi: 10.1007/s00198-021-05824-7. Epub 2021 Jan 18.
Prevalence and risk factors of vertebral fractures in postmenopausal RA women were assessed in 323 patients and compared with 660 age-matched women. Of patients, 24.15% had at least one vertebral fracture vs.16.06% of controls. Age, glucocorticoids and falls were the main fracture risks. Vertebral fractures were associated with disease severity.
There is little quality data on the updated prevalence of fractures in rheumatoid arthritis (RA) that may have changed due to advances in the therapeutic strategy in recent years. This study was aimed at analysing the prevalence and risk factors of vertebral fractures in postmenopausal women with RA and comparing it with that of the general population.
We included 323 postmenopausal women diagnosed with RA from 19 Spanish Rheumatology Departments, randomly selected and recruited in 2018. Lateral radiographs of the thoracic and lumbar spine were obtained to evaluate morphometric vertebral fractures and the spinal deformity index. We analysed subject characteristics, factors related to RA, and fracture risk factors. The control group consisted of 660 age-matched Spanish postmenopausal women from the population-based Camargo cohort.
Seventy-eight (24.15%) RA patients had at least one vertebral fracture. RA patients had increased fracture risk compared with controls (106 of 660, 16.06%) (p = 0.02). Logistic regression analysis showed that age (OR 2.17; 95% CI 1.27-4.00), glucocorticoids (OR 3.83; 95% CI 1.32-14.09) and falls (OR 3.57; 95% CI 1.91-6.86) were the independent predictors of vertebral fractures in RA patients. The subgroup with vertebral fractures had higher disease activity (DAS28: 3.15 vs. 2.78, p = 0.038) and disability (HAQ: 0.96 vs. 0.63, p = 0.049), as compared with those without vertebral fractures.
The risk of vertebral fracture in RA is still high in recent years, when compared with the general population. The key determinants of fracture risk are age, glucocorticoids and falls. Patients with vertebral fractures have a more severe RA.
评估 323 例绝经后类风湿关节炎（RA）女性患者的椎体骨折发生率及其风险因素，并与 660 例年龄匹配的女性进行比较。结果：24.15%的患者存在至少一处椎体骨折，而对照组为 16.06%。年龄、糖皮质激素和跌倒为主要骨折风险因素。椎体骨折与疾病严重程度相关。方法：我们纳入了来自 19 个西班牙风湿病科的 323 例绝经后 RA 女性患者，这些患者是 2018 年随机选择并招募的。获取胸腰椎侧位片以评估形态计量学椎体骨折和脊柱畸形指数。我们分析了患者的特征、与 RA 相关的因素以及骨折风险因素。对照组由来自人群基础的卡马戈队列的 660 例年龄匹配的西班牙绝经后女性组成。结论：与一般人群相比，近年来 RA 患者的椎体骨折风险仍然较高。骨折风险的关键决定因素是年龄、糖皮质激素和跌倒。存在椎体骨折的患者具有更严重的 RA。
