OSTEOPOROTIC FRACTURE RISK IN RHEUMATOID ARTHRITIS

Objective: Osteoporosis is an extra-articular complication of rheumatoid arthritis (RA) with increased risk of fractures. FRAX is an online tool for assessing risk of osteoporotic fracture. However, the relationship between the FRAX score and disease specific risk factors has not yet been investigated in RA. Hence, we assessed 10-year fracture risk using FRAX and its relationship with disease activity score, inflammation and disease duration in RA.Methods: 50 RA patients enrolled and recruited consecutively in a special camp organized for RA patients on the occasion of World Osteoporosis Day, 2016to estimate the osteoporotic fracture risk from Rheumatology clinic. Predicted 10-year risk of hip fracture and major osteoporotic fracture (MOF) by FRAX score without information on bone mineral density (BMD). Inflammatory disease activity measures included disease activity score of 28 joints (DAS28), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were also measured. FRAX score also estimated in 40 age and sex matched healthy controls.Results: FRAX estimated significantly enhanced fracture risk in active RA, both for MOF (13.34±1.26%) and hip fracture (6.84±1.03%) as compared to controls for MOF (5.46±0.95%) and hip fracture (1.97±0.49%). In RA patients, MOF and hip fracture risk correlated with DAS28 and disease duration and MOF risk correlated with ESR and CRP.Conclusion: Active RA patients, even in the absence of BMD have an increased FRAX score indicating an enhanced 10-year probability of MOF and hip fracture. Long disease duration, high disease activity and an elevated ESR and CRP are potential disease specific risk factors for osteoporotic fractures in RA.