Mochizuki Takeshi, Yano Koichiro, Otani Naoko, Hiroshima Ryo, Ikari Katsunori, Okazaki Ken
Department of Orthopedic Surgery, Kamagaya General Hospital, 929-6 Hatsutomi, Kamagaya, Chiba, 273-0121, Japan.
Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan.
J Bone Miner Metab. 2025 Mar 27. doi: 10.1007/s00774-025-01597-9.
Patients with rheumatoid arthritis (RA) are at an increased risk of osteoporosis and vertebral fractures. We investigated the risk factors for vertebral fractures and severe vertebral fractures in patients with RA, including comorbidities and urinary pentosidine levels.
This study included 637 patients with available clinical data on urinary pentosidine levels, vertebral fractures, and comorbidities. Vertebral fractures were evaluated using plain X-ray imaging. Comorbidities considered relevant to osteoporosis were type 2 diabetes mellitus, chronic kidney disease, and lung diseases.
The prevalence of vertebral fractures in this cohort was 30.1%. Patients with vertebral fracture Patients with vertebral fractures were significantly more likely to be older [odds ratio (OR) 1.075; 95% confidence interval (CI) 1.049-1.1.03], had higher prevalence of comorbidities (OR 1.770; 95% CI 1.138-2.753), higher urinary pentosidine levels (OR 1.028; 95% CI 1.013-1.044), higher history of non-vertebral fractures (OR 2.084; 95% CI 1.222-3.557), and lower total hip T-score (OR 0.526; 95% CI 0.329-0.841) than patients without vertebral fractures. Among patients with vertebral fractures, 54.2% had severe vertebral fractures. Patients with severe vertebral fractures were more likely to have lower lumbar spine T-scores (OR 0.768; 95% CI 0.622-0.949) than patients with non-severe vertebral fractures.
This study identified factors associated with vertebral fractures and severe vertebral fractures in patients with RA. Notably, vertebral fractures were associated with comorbidities and urinary pentosidine levels. In patients with RA and vertebral fractures, low BMD in the lumbar spine was a significant factor associated with severe vertebral fractures.
类风湿关节炎（RA）患者发生骨质疏松和椎体骨折的风险增加。我们调查了RA患者椎体骨折和严重椎体骨折的危险因素，包括合并症和尿中戊糖苷水平。
本研究纳入了637例有尿中戊糖苷水平、椎体骨折和合并症相关临床数据的患者。使用普通X线成像评估椎体骨折。与骨质疏松相关的合并症包括2型糖尿病、慢性肾脏病和肺部疾病。
该队列中椎体骨折的患病率为30.1%。椎体骨折患者比无椎体骨折患者更可能年龄较大[比值比（OR）1.075；95%置信区间（CI）1.049 - 1.1.03]，合并症患病率更高（OR 1.770；95% CI 1.138 - 2.753），尿中戊糖苷水平更高（OR 1.028；95% CI 1.013 - 1.044），非椎体骨折病史更多（OR 2.084；95% CI 1.222 - 3.557），全髋部T值更低（OR 0.526；95% CI 0.329 - 0.841）。在椎体骨折患者中，54.2%有严重椎体骨折。严重椎体骨折患者比非严重椎体骨折患者更可能腰椎T值较低（OR 0.768；95% CI 0.622 - 0.949）。
本研究确定了RA患者椎体骨折和严重椎体骨折的相关因素。值得注意的是，椎体骨折与合并症和尿中戊糖苷水平相关。在有椎体骨折的RA患者中，腰椎低骨密度是与严重椎体骨折相关的重要因素。
