Researchers evaluated the prevalence and fracture risk of osteoporosis in patients with rheumatoid arthritis (RA), and compared the fracture risk assessment tool (FRAX) criteria and bone mineral density (BMD) criteria established by the World Health Organization (WHO)

The fracture risk assessment tool (FRAX) criteria and the bone mineral density (BMD) criteria established by the World Health Organization (WHO) are widely used for the risk assessment of osteoporotic fractures. The WHO criteria, using BMD measured by dual-energy X-ray absorptiometry (DXA), are the most widely used in the diagnosis of osteoporosis.

The management guidelines for the prevention and treatment of osteoporosis, developed by an expert committee of the National Osteoporosis Foundation (NOF), are also based on BMDs. In particular, RA is the only disease risk factor in the FRAX model, even though the input for RA is just a dichotomous variable.

High-risk osteoporotic fractures

This retrospective cross-sectional study, which included 479 RA patients in 5 hospitals, was conducted between January 2012 and December 2016. The FRAX criteria for high-risk osteoporotic fractures were calculated including and excluding the BMD values, respectively.

The definition of high risk for fracture by FRAX criteria and BMD criteria by WHO was 10-year probability of ≥ 20% for major osteoporotic fracture or ≥ 3% for hip fracture, and T score ≤ -2.5 or Z score ≤ -2.0, respectively.

The mean age was 61.7 ± 11.9 years. The study included 426 female patients (88.9%), 353 (82.9%) of whom were postmenopausal. Osteoporotic fractures were detected in 81 (16.9%) patients.

The numbers of candidates for pharmacological intervention using the FRAX criteria with and without BMD and the WHO criteria were 226 (47.2%), 292 (61%), and 160 (33.4%), respectively. Only 69.2%?77% of the patients in the high-risk group using the FRAX criteria were receiving osteoporosis treatments.

The following were significant using the WHO criteria: female (OR 3.55, 95% CI 1.46?8.63), age (OR 1.1, 95% CI 1.08?1.13), and BMI (OR 0.8, 95% CI 0.75?0.87). Glucocorticoid dose (OR 1.09, 95% CI 1.01?1.17), age (OR 1.09, 95% CI 1.06?1.12), and disease duration (OR 1.01, 95% CI 1?1.01) were independent risk factors for fracture.

The proportion of RA patients with a high risk of osteoporotic fractures was 33.4%?61%. Only 69.2%?77% of candidate patients were receiving osteoporotic treatments while applying FRAX criteria. Independent risk factors for osteoporotic fractures in RA patients were age, the dose of glucocorticoid, and disease duration