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Osteoporosis International
Published in: Osteoporosis International 2/2012

01-02-2012 | Original Article

Prevalence of vertebral fractures in patients with rheumatoid arthritis: revisiting the role of glucocorticoids

Authors: M. Ghazi, S. Kolta, K. Briot, J. Fechtenbaum, S. Paternotte, C. Roux

Published in: Osteoporosis International | Issue 2/2012

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Abstract

Summary

Vertebral fracture assessment (VFA) is a convenient tool for the diagnosis of vertebral fracture in RA. Optimal control of inflammation may be an effective means to protect against vertebral fractures.

Introduction

The aim of this case–control study was to assess the prevalence of vertebral fractures (VFs) in patients with RA using VFA technology.

Methods

Consecutive women (N = 101, 56.1 ± 14.2 years) with RA (mean disease duration, 14.9 ± 10 years) were recruited in the study. Clinical and biological statuses and treatments including glucocorticoids were assessed. Controls (N = 303), randomly selected from the general population, were individually matched to each case for age.

Results

The prevalences of osteoporosis were 55.4% and 10.5% in patients and controls, respectively. Among the subjects, 21.7% and 4.2% had a vertebral fracture in the RA and control groups, respectively. Compared with controls, patients with RA had an increased risk of VFs: odds ratio (OR) (CI 95%) adjusted on body mass index was 6.5 (3.1, 13.9). In a multiple logistic regression analysis, VFs were independently associated with presence of non-vertebral fractures (OR = 9.2 [2.5–33.5]), presence of a fall in the previous year (OR = 4.6 [1.2–18.3]), current use of disease-modifying anti-rheumatic drugs (DMARDs) (OR = 0.05 [0.004, 0.51]) and current use of steroids (OR = 0.17 [0.04, 0.67]).

Conclusion

Rheumatoid arthritis is a risk factor of VF (OR = 6.5). VFA is a convenient tool for this diagnosis. Presence of VF is inversely related to the use of DMARD and glucocorticoids, enhancing the hypothesis that an appropriate control of the disease may be a protective factor against bone fragility.
Literature
1.
van Staa TP, Geusens P, Bijlsma WJ et al (2006) Clinical assessment of the long-term risk of fracture in patients with rheumatoid arthritis. Arthritis Rheum 54:3104–3112PubMedCrossRef
2.
Orstavik RE, Haugeberg G, Mowinckel P et al (2004) Vertebral deformities in rheumatoid arthritis. Arch Intern Med 164:420–425PubMedCrossRef
3.
de Nijs RNJ, Jacobs JWG, Bijlsma JWJ, on behalf of the Osteoporosis Working Group of the Dutch Society for Rheumatology et al (2001) Prevalence of vertebral deformities and symptomatic vertebral fractures in corticosteroid treated patients with rheumatoid arthritis. Rheumatology 40:1375–1383PubMedCrossRef
4.
Sinigaglia L, Nervetti A, Mela Q et al (2000) High prevalence of vertebral deformities in elderly patients with early rheumatoïd arthritis. Italian Study Group on Bone Mass in Rheumatoid Arthritis. J Rheumatol 27:2582–2589PubMed
5.
Spector TD, Hall GM, Mc Closkey EV et al (1993) Risk of vertebral fracture in women with rheumatoid arthritis. BMJ 306:558PubMedCrossRef
6.
Peel NF, Moore DJ, Barrington NA et al (1995) Risk of vertebral fracture and relationship to bone mineral density in steroid treated rheumatoid arthritis. Ann Rheum Dis 54:801–806PubMedCrossRef
7.
Damiano J, Kolta S, Porcher R et al (2006) Diagnosis of vertebral fractures by vertebral fracture assessment. J Clin Densitom 9:66–71PubMedCrossRef
8.
Schousboe JT, Debold CR (2006) Reliability and accuracy of vertebral fracture assessment with densitometry compared to radiography in clinical practice. Osteoporos Int 17:281–289PubMedCrossRef
9.
Schousboe JT, Vokes T, Broy SB et al (2008) Vertebral fracture assessment: the 2007 ISCD official positions. J Clin Densitom 11:92–108PubMedCrossRef
10.
Orstavik RE, Haugeberg G, Uhlig T et al (2005) Incidence of vertebral deformities in 255 female rheumatoid arthritis patients measured by morphometric X-ray absorptiometry. Osteoporos Int 16:35–42PubMedCrossRef
11.
Ursum J, Britsemmer K, van Schaardenburg D et al (2009) High prevalence of vertebral deformities in elderly patients with early rheumatoid arthritis. Ann Rheum Dis 68:1512–1513PubMedCrossRef
12.
Wijbrandts CA, Klaasen R, Dijkgraaf MGW et al (2009) Bone mineral density in rheumatoid arthritis patients 1 year after adalimumab therapy: arrest of bone loss. Ann Rheum Dis 68:373–376PubMedCrossRef
13.
Glüer CC, Eastell R, Reid DM et al (2004) Association of five quantitative ultrasound devices and bone densitometry with osteoporotic vertebral fractures in a population-based sample: the OPUS study. J Bone Miner Res 19:782–793PubMedCrossRef
14.
Genant HK, Wu CY, van Kuijk C et al (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148PubMedCrossRef
15.
Genant HK, Li J, Wu CY et al (2000) Vertebral fractures in osteoporosis: a new method for clinical assessment. J Clin Densitom 3:281–290PubMedCrossRef
16.
Rea JA, Li J, Blake GM et al (2000) Visual assessment of vertebral deformity by X-ray absorptiometry: a highly predictive method to exclude vertebral deformity. Osteoporos Int 11:660–668PubMedCrossRef
17.
Ferrar L, Jiang G, Barrington NA et al (2000) Identification of vertebral deformities in women: comparison of radiological assessment and quantitative morphometry using morphometric radiography and morphometric X-ray absorptiometry. J Bone Miner Res 15:575–585PubMedCrossRef
18.
Orstavik RE, Haugeberg G, Uhlig T et al (2003) Vertebral deformities in 229 female patients with rheumatoid arthritis: associations with clinical variables and bone mineral density. Arthritis Rheum 3:355–360CrossRef
19.
O’Neill TW, Felsenberg D, Varlow J et al (1996) The prevalence of vertebral deformity in European men and women. The European Vertebral Osteoporosis Study. J Bone Miner Res 11:1010–1018PubMedCrossRef
20.
Haugeberg G, Uhlig T, Falch JA et al (2000) Bone mineral density and frequency of osteoporosis in female patients with rheumatoid arthritis: results from 394 patients in the Oslo County Rheumatoid Arthritis register. Arthritis Rheum 43:522–530PubMedCrossRef
21.
Roux C, Fechtenbaum J, Kolta S et al (2007) Mild prevalent and incident vertebral fractures are risk factors for new fractures. Osteoporos Int 18:1617–1624PubMedCrossRef
22.
Fechtenbaum J, Cropet C, Kolta S et al (2005) Reporting of vertebral fractures on spine X-rays. Osteoporos Int 16:1823–1826PubMedCrossRef
23.
Martin JC, Munro R, Campbell MK et al (1997) Effects of disease and corticosteroids on appendicular bone mass in postmenopausal women with rheumatoid arthritis: comparison with axial measurements. Br J Rheumatol 36:43–49PubMedCrossRef
24.
Lodder MC, de Jong Z, Kostense PJ et al (2004) Bone mineral density in patients with rheumatoid arthritis: relation between disease severity and low bone mineral density. Ann Rheum Dis 63:1576–7580PubMedCrossRef
25.
Lodder MC, Haugeberg G, Lems WF et al (2003) Radiographic damage associated with low bone mineral density and vertebral deformities in rhumatoid arthritis: the Oslo-Truro-Amsterdam (OSTRA) collaborative study. Arthritis Rheum 49:209–215PubMedCrossRef
26.
Smith MD, Cheah SP, Taylor K et al (2001) Prevention of corticosteroid induced osteoporosis in inpatients recently discharged from a tertiary teaching hospital. J Rheumatol 28:566–570PubMed
27.
Curtis JR, Westfall AO, Allison J et al (2007) Challenges in improving the quality of osteoporosis care for long-term glucocorticoid users: a prospective randomized trial. Arch Intern Med 167:591–596PubMedCrossRef
28.
Solomon DH, Katz JN, Cabral D et al (2006) Osteoporosis management in patients with rheumatoid arthritis: evidence for improvement. Arthritis Rheum 55:873–877PubMedCrossRef
29.
Gough AK, Lilley J, Eyre S et al (1994) Generalised bone loss in patients with early rheumatoid arthritis. Lancet 344:23–27PubMedCrossRef
30.
Vosse D, Landewé R, van der Heijde D et al (2009) Ankylosing spondylitis and the risk of fracture: results from a large primary care-based nested case-control study. Ann Rheum Dis 68:1839–1842PubMedCrossRef
31.
Cooper C, Carbone L, Michet CJ et al (1994) Fracture risk in patients with ankylosing spondylitis: a population based study. J Rheumatol 21:1877–1882PubMed
32.
Maillefert JF, Aho S, El Maghraoui A et al (2001) Changes in bone density in patients with ankylosing spondylitis: a 2 year follow-up study. Osteoporos Int 12:605–609PubMedCrossRef
33.
Schett G, Kiechl S, Weger S et al (2006) High-sensitivity c-reactive protein and risk of nontraumatic fractures in the Bruneck study. Arch Intern Med 166:2495–2501PubMedCrossRef
34.
Kroot EJJA, Nieuwenhuizen MG, de Waal Malefijt MC et al (2001) Change in bone mineral density in patients with rheumatoid arthritis during the first decade of the disease. Arthritis Rheum 44:1254–1260PubMedCrossRef
35.
Haugeberg G, Strand A, Kvien TK et al (2005) Reduced loss of hand bone density with prednisolone in early rheumatoid arthritis: results from a randomized placebo controlled trial. Arch Intern Med 165:1293–1297PubMedCrossRef
36.
Hayashibara M, Hagino H, Katagiri H et al (2010) Incidence and risk factors of falling in ambulatory patients with rheumatoid arthritis: a prospective 1-year study. Osteoporos Int 21:1825–1833PubMedCrossRef
37.
Jamison M, Neuberger GB, Miller PA et al (2003) Correlates of falls and fear of falling among adults with rheumatoid arthritis. Arthritis Rheum 49:673–680PubMedCrossRef
38.
Giles JT, Ling SM, Ferrucci L et al (2008) Abnormal body composition phenotypes in older rheumatoid arthritis patients: association with disease characteristics and pharmacotherapies. Arthritis Rheum 59:807–815PubMedCrossRef
39.
Metadata
Title
Prevalence of vertebral fractures in patients with rheumatoid arthritis: revisiting the role of glucocorticoids
Authors
M. Ghazi
S. Kolta
K. Briot
J. Fechtenbaum
S. Paternotte
C. Roux
Publication date
01-02-2012
Publisher
Springer-Verlag
Published in
Osteoporosis International / Issue 2/2012
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-011-1584-3

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