10-year probability of major osteoporotic fractures in women with rheumatoid arthritis by the Ukrainian FRAX model
Keywords:rheumatoid arthritis, women, 10-year probability of fracture, FRAX
AbstractBackground. The timely assessment of the osteoporotic fracture risk in patients with rheumatoid arthritis (RA) is extremely relevant; it is possible due to the use of the Fracture Risk Assessment Tool (FRAX®) and X-ray absorptiometry (DХA). Now Ukraine has its own FRAX model, certain limits have been set for the initiation of antiosteoporotic treatment; however, the FRAX informative value for the RA patients has not been sufficiently studied. The aim is to study the 10-year risk of major osteoporotic fractures and hip fractures in women with RA using the Ukrainian FRAX model. Materials and methods. Two hundred and thirty women aged 43–73 years were examined, among them 110 patients had RA. The subjects did not differ significantly as to the parameters of age, body weight, age of menopause and its duration. Fracture risk was calculated without DXA indices, and the percentage of women requiring additional examination or treatment was also calculated according to the recommended intervention limits of the Ukrainian FRAX model. The analysis of the results was performed in different age subgroups, depending on the presence of early menopause and the duration of postmenopause. Results. Patients with RA had significantly higher rates of osteoporotic fractures and hip fractures compared to controls (7.6 [5.7–11.0] and 4.3 [3.0–7.7] %, p = 0.0000001, and 1.4 [0.8–2.5] and 0.7 [0.3–1.7] %; p = 0.0000001, respectively). 24.5 % of women with RA and 6.7 % of controls had low-energy fractures (p < 0.001), with those receiving glucocorticoids being 62.7 and 1.7 % in the groups, respectively (p < 0.0001). 33.6 % of RA patients and 5 % of controls required treatment without additional examination, while 24.2 % of controls did not require DXA due to the low FRAX indices. Conclusions. Women with RA have significantly higher FRAX parameters than healthy ones, and about 1/3 of them require antiosteoporotic treatment without additional examination, which should be considered in order to reduce the risk of osteoporotic fractures.
Lin Y.J., Anzaghe M., Schülke S. Update on the Pathomechanism, Diagnosis, and Treatment Options for Rheumatoid Arthritis. Cells. 2020. 9(4). Pii. E880. doi: 10.3390/cells9040880.
Sparks J.A. Rheumatoid Arthritis. Ann. Intern. Med. 2019. 170(1). ITC. 1-16. doi: 10.7326/AITC201901010.
Adami G., Saag K.G. Osteoporosis Pathophysiology, Epidemiology, and Screening in Rheumatoid Arthritis. Curr. Rheumatol. Rep. 2019. 21(7). P. 34. doi: 10.1007/s11926-019-0836-7.
Дыдыкина И.С., Алексеева Л.И. Остеопороз при ревматоидном артрите: диагностика, факторы риска, переломы, лечение. Научно-практическая ревматология. 2011. № 3. С. 13-17.
Поворознюк В.В., Карасевська Т.А., Дзерович Н.І. Мінеральна щільність кісткової тканини та рентгеноморфометричні індекси аксіального скелета у хворих на глюкокортикоїд-індукований остеопороз. Біль. Суглоби. Хребет. 2011. 1(01). http://www.mif-ua.com/archive/article/16206.
Поворознюк В.В., Григорьева Н.В. Роль FRAX в прогнозировании риска переломов. Новости медицины и фармации. 2011. 16(379). http://www.mif-ua.com/ archive/article/21687.
Поворознюк В.В., Григор’єва Н.В., Kanis J.A. et al. Українська версія FRAX: критерії діагностики й лікування остеопорозу. Біль. Суглоби. Хребет. 2019. 9(4). С. 9-16. doi: 10.22141/2224-1507.9.4.2019.191921.
Lai E.L., Huang W.N., Chen H.H. et al. Ten-year fracture risk by FRAX and osteoporotic fractures in patients with systemic autoimmune diseases. Lupus. 2019. 28(8). P. 945-953. doi: 10.1177/0961203319855122.
Povoroznyuk V.V., Grygorieva N.V., Kanis J.A. et al. Epidemiology of hip fracture and the development of FRAX in Ukraine. Arch. Osteoporos. 2017. 12(1). P. 53. doi: 10.1007/s11657-017-0343-2.
Wang Y., Hao Y.J., Deng X.R. et al. Risk factors for bone mineral density changes in patients with rheumatoid arthritis and fracture risk assessment. Beijing Da Xue Xue Bao Yi Xue Ban. 2015. 47(5). P. 781-786.
Choi S.T., Kwon S.R., Jung J.Y. et al. Prevalence and Fracture Risk of Osteoporosis in Patients with Rheumatoid Arthritis: A Multicenter Comparative Study of the FRAX and WHO Criteria. J. Clin. Med. 2018. 7(12). Pii. E507. doi: 10.3390/jcm7120507.
Phuanudom R., Lektrakul N., Katchamart W. The association between 10-year fracture risk by FRAX and osteoporotic fractures with disease activity in patients with rheumatoid arthritis. Clinical Rheumatology. 2018. 37. Р. 2603-2610. doi: 10.1007/s10067-018-4218-8.
Elde K.D., Madsen O.R. FRAX 10-yr fracture risk in rheumatoid arthritis — assessments with and without bone mineral density may lead to very different results in the individual patient. Journal of Clinical Densitometry. 2019. 22(1). P. 31-38. doi: 10.1016/j.jocd.2018.10.007.
Broy S.B., Tanner S.B. FRAX® Position Development Conference Members. Official Positions for FRAX® clinical regarding rheumatoid arthritis from Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®. J. Clin. Densitom. 2011. 14(3). P. 184-189. doi: 10.1016/j.jocd.2011.05.012.
Leib E.S., Saag K.G., Adachi J.D. et al. FRAX® Position Development Conference Members. Official Positions for FRAX® clinical regarding glucocorticoids: the impact of the use of glucocorticoids on the estimate by FRAX® of the 10 year risk of fracture from Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®. J. Clin. Densitom. 2011. 14(3). Р. 212-219. doi: 10.1016/j.jocd.2011.05.014.
Kanis J.A., Johansson H., Oden A. et al. Guidance for the adjustment of FRAX according to the dose of glucocorticoids. Osteoporos Int. 2011. 22(3). Р. 809-816. doi: 10.1007/s00198-010-1524-7.
Copyright (c) 2020 TRAUMA
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our edition uses the copyright terms of Creative Commons for open access journals.
Authors, who are published in this journal, agree with the following terms:
- The authors retain rights for authorship of their article and grant to the edition the right of first publication of the article on a Creative Commons Attribution 4.0 International License, which allows others to freely distribute the published article, with the obligatory reference to the authors of original works and original publication in this journal.
- Directing the article for the publication to the editorial board (publisher), the author agrees with transmitting of rights for the protection and using the article, including parts of the article, which are protected by the copyrights, such as the author’s photo, pictures, charts, tables, etc., including the reproduction in the media and the Internet; for distributing; for the translation of the manuscript in all languages; for export and import of the publications copies of the writers’ article to spread, bringing to the general information.
- The rights mentioned above authors transfer to the edition (publisher) for the unlimited period of validity and on the territory of all countries of the world.
- The authors guarantee that they have exclusive rights for using of the article, which they have sent to the edition (publisher). The edition (the publisher) is not responsible for the violation of given guarantees by the authors to the third parties.
- The authors have the right to conclude separate supplement agreements that relate to non-exclusive distribution of their article in the form in which it had been published in the journal (for example, to upload the work to the online storage of the journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this journal is included.
- The policy of the journal permits and encourages the publication of the article in the Internet (in institutional repository or on a personal website) by the authors, because it contributes to productive scientific discussion and a positive effect on efficiency and dynamics of the citation of the article.
- The rights to the article are deemed transferred by the authors to the edition (the publisher) since the moment of the publication of the article in the printed or electronic version of journal.