Ramos Fernanda P, Pinheiro Marcela M C, Silva Luiza V A, Viner Eliana P C, Szejnfeld Vera L, Castro Charlles H M
Rheumatology Division, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil.
Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), Rua dos Otonis, 863. Vila Clementino, São Paulo, CEP, 04025-002, Brazil.
Calcif Tissue Int. 2025 Aug 25;116(1):113. doi: 10.1007/s00223-025-01419-0.
Rheumatoid arthritis (RA) has a higher risk of fractures that is often neglected. We determined the prevalence and risk factors for fractures in women with longstanding RA. Consecutive women with RA from a tertiary hospital underwent bone densitometry (DXA) and spine radiography with morphometric analysis. Disease characteristics, activity, and medication use were assessed. Logistic and linear regression analyses identified risk factors for osteoporosis and fractures. The study included 179 women with RA aged 65.1 ± 9.7 years with a median disease duration of 21 (12.5) years (72% positive for rheumatoid factor). Glucocorticoid (GC), csDMARDs, b/tsDMARDs use, and current moderate-to-high disease activity were observed in 26.3%, 92.7%, 58.6%, and 45.3% of the patients, respectively. Densitometric osteoporosis and fractures were found in 43.6% and 28.5% of the patients, respectively. Fractures were observed in 51 patients (28.5%), primarily occurring at the spine (N = 43) and forearm (N = 10). Almost half of the patients with fractures (N = 24) had a BMD T-score greater than - 2.5. BMI (OR 0.916; 95%CI 0.854-0.983; P = 0.015) and smoking load (OR 1.023; 95%CI 1.002-1.044; P = 0.032) were predictors for osteoporosis, while cumulative 5-year disease activity (OR 3.474; 95%CI 1.557-7.751; P = 0.002) and total femur T-score (OR 0.646; 95%CI 0.436-0.956; P = 0.029) were predictors of fractures. Current GC dose and femoral neck T-score were predictors of spinal deformity index (R = 0.108; P < 0.001). Almost half of the women with longstanding RA presenting with fractures had BMD values above the osteoporotic range. Moderate-to-high cumulative 5-year disease activity, GC use, and lower BMD at the proximal femur were risk factors for fractures.
类风湿关节炎（RA）患者发生骨折的风险较高，这一点常常被忽视。我们确定了长期患RA女性骨折的患病率及风险因素。来自一家三级医院的连续的RA女性患者接受了骨密度测定（DXA）以及脊柱X线摄影和形态计量分析。评估了疾病特征、活动情况及用药情况。逻辑回归和线性回归分析确定了骨质疏松症和骨折的风险因素。该研究纳入了179名年龄为65.1±9.7岁、中位病程为21（12.5）年的RA女性患者（72%类风湿因子阳性）。分别有26.3%、92.7%、58.6%和45.3%的患者使用糖皮质激素（GC）、传统合成改善病情抗风湿药（csDMARDs）、生物制剂或靶向合成改善病情抗风湿药（b/tsDMARDs）以及目前疾病活动度为中度至高度。分别有43.6%和28.5%的患者存在骨密度测定骨质疏松症和骨折。51名患者（28.5%）发生了骨折，主要发生在脊柱（n = 43）和前臂（n = 10）。几乎一半发生骨折的患者（n = 24）骨密度T值大于 - 2.5。体重指数（OR 0.916；95%CI 0.854 - 0.983；P = 0.015）和吸烟量（OR 1.023；95%CI 1.002 - 1.044；P = 0.032）是骨质疏松症的预测因素，而累积5年疾病活动度（OR 3.474；95%CI 1.557 - 7.751；P = 0.002）和股骨总T值（OR 0.646；95%CI 0.436 - 0.956；P = 0.029）是骨折的预测因素。目前的GC剂量和股骨颈T值是脊柱畸形指数的预测因素（R = 0.108；P < 0.001）。几乎一半发生骨折的长期患RA女性患者的骨密度值高于骨质疏松范围。累积5年中度至高度疾病活动度、使用GC以及股骨近端较低的骨密度是骨折的风险因素。
