Bone mineral density and fractures in patients with rheumatoid arthritis: the DXA-HIP project

Abstract

Objectives: RA is a chronic disabling disease affecting 0.5-1% of adults worldwide. People with RA have a greater prevalence of multimorbidity, particularly osteoporosis and associated fractures. Recent studies suggest that fracture risk is related to both non-RA and RA factors, whose importance is heterogeneous across studies. This study seeks to compare baseline demographic and DXA data across three cohorts: healthy controls, RA patients and a non-RA cohort with major risk factors and/or prior major osteoporotic fracture (MOF).

Methods: This is a cross-sectional study using data collected from three DXA centres in the west of Ireland from January 2000 to November 2018.

Results: Data were available for 30 503 subjects who met our inclusion criteria: 9539 (31.3%) healthy controls, 1797 (5.9%) with RA and 19 167 (62.8%) others. Although age, BMI and BMD were similar between healthy controls, the RA cohort and the other cohort, 289 (16.1%) RA patients and 5419 (28.3%) of the non-RA cohort had prior MOF. In the RA and non-RA cohorts, patients with previous MOF were significantly older and had significantly lower BMD at the femoral neck, total hip and spine.

Conclusion: Although age, BMI and BMD were similar between a healthy control cohort and RA patients and others with major fracture risk factors, those with a previous MOF were older and had significantly lower BMD at all three measured skeletal sites. Further studies are needed to address the importance of these and other factors for identifying those RA patients most likely to experience fractures.

Keywords: BMD; DXA; fracture; rheumatoid arthritis; risk factor.

Figure 1.

Derivation of the cohorts

Figure 2.

Femoral neck BMD in subjects with and without major osteoporotic fractures. (A) female subjects. (B) male subjects