Moderate-to-High 5-Year Cumulative Disease Activity and Lower Bone Mineral Density at the Proximal Femur are Major Predictors of Fragility Fractures in Women with Longstanding Rheumatoid Arthritis: An Observational Cohort Study.

Abstract

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 (R² = 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.