Dr Mohammad Jahangir Ul Alam, Assistant Professor, Department of Medicine, Sir Salimullah Medical College & Mitford Hospital, Dhaka, Bangladesh; E-mail:
Mymensingh Med J. 2023 Oct;32(4):1084-1090.
Rheumatoid arthritis (RA) is the most common inflammatory arthritis affecting 0.5-1.0% of the general population worldwide and although RA is properly considered a disease of the joints, it can cause a variety of extra-articular manifestations. This study was performed to find out any discrepancy in fracture risk estimates with and without bone mineral density (BMD) in rheumatoid arthritis (RA) patients. This observational cross-sectional study was carried out in the Department of Rheumatology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from July 2013 to July 2015. Total 65 consecutive patients with RA fulfilling ACR/EULAR criteria aged 40-90 year were recruited. Ten year fracture risk of these patients was evaluated by the FRAX score with and without BMD and differences were observed. FRAX score without BMD revealed that major fracture risk was low in 58(89.2%) patients, moderate in 7(10.8%) patients but re-estimation with BMD revealed that 55(84.6%) patients remained in low risk group, 8(12.3%) patients in moderate risk group and 2(3.1%) patients went to the high risk group. In case of hip fracture risk without BMD, risk was low in 58(89.2%) patients, high in 7(10.8%) patients; but with BMD, 50(76.9%) patients remained in low risk group but risk of 15(23.1%) patients became high. Almost all the high risk patients (93.3%) were ≥55 years of age. Increasing age, female sex, disease duration and use of steroid were positively correlated with increased FRAX score where as high BMI and high BMD were associated with low FRAX score. But in multivariate analysis it was found that only relation with age was at statistically significant level. Significant numbers of patients with rheumatoid arthritis have high risk of fracture especially hip fracture. The mean of FRAX score increased in both major & hip osteoporotic fracture risk after adding BMD. More than half of the patients above fifty five years or more had high risk of fracture. So, BMD should be done in patients aged more than fifty five.
类风湿关节炎（RA）是全世界最常见的炎性关节炎，影响 0.5-1.0%的普通人群。尽管 RA 被认为是一种关节疾病，但它会引起各种关节外表现。本研究旨在确定在类风湿关节炎（RA）患者中，不考虑骨密度（BMD）和考虑 BMD 时，骨折风险估计值是否存在差异。这项观察性横断面研究于 2013 年 7 月至 2015 年 7 月在孟加拉国 Bangabandhu Sheikh Mujib 医科大学（BSMMU）风湿病科进行。共招募了 65 名符合 ACR/EULAR 标准的连续 RA 患者，年龄 40-90 岁。使用 FRAX 评分评估这些患者的 10 年骨折风险，同时评估有无 BMD，并观察差异。不考虑 BMD 的 FRAX 评分显示，58 名（89.2%）患者的主要骨折风险较低，7 名（10.8%）患者的风险中等，但重新考虑 BMD 后，55 名（84.6%）患者仍处于低风险组，8 名（12.3%）患者处于中风险组，2 名（3.1%）患者处于高风险组。不考虑 BMD 的髋部骨折风险，58 名（89.2%）患者的风险较低，7 名（10.8%）患者的风险较高；但考虑 BMD 后，50 名（76.9%）患者仍处于低风险组，但 15 名（23.1%）患者的风险变为高风险。几乎所有高风险患者（93.3%）年龄均≥55 岁。FRAX 评分与年龄增长、女性、疾病持续时间和使用类固醇呈正相关，而高 BMI 和高 BMD 与低 FRAX 评分相关。但多变量分析发现，只有与年龄的关系具有统计学显著性水平。相当数量的类风湿关节炎患者骨折风险较高，尤其是髋部骨折风险较高。添加 BMD 后，主要和髋部骨质疏松性骨折风险的 FRAX 评分均值均增加。超过一半的 55 岁以上患者有骨折高风险。因此，应在 55 岁以上患者中进行 BMD 检测。
