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Vertebral fractures are increased in rheumatoid arthritis despite recent therapeutic advances: a case-control study

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Abstract

Summary

Prevalence and risk factors of vertebral fractures in postmenopausal RA women were assessed in 323 patients and compared with 660 age-matched women. Of patients, 24.15% had at least one vertebral fracture vs.16.06% of controls. Age, glucocorticoids and falls were the main fracture risks. Vertebral fractures were associated with disease severity.

Introduction

There is little quality data on the updated prevalence of fractures in rheumatoid arthritis (RA) that may have changed due to advances in the therapeutic strategy in recent years. This study was aimed at analysing the prevalence and risk factors of vertebral fractures in postmenopausal women with RA and comparing it with that of the general population.

Methods

We included 323 postmenopausal women diagnosed with RA from 19 Spanish Rheumatology Departments, randomly selected and recruited in 2018. Lateral radiographs of the thoracic and lumbar spine were obtained to evaluate morphometric vertebral fractures and the spinal deformity index. We analysed subject characteristics, factors related to RA, and fracture risk factors. The control group consisted of 660 age-matched Spanish postmenopausal women from the population-based Camargo cohort.

Results

Seventy-eight (24.15%) RA patients had at least one vertebral fracture. RA patients had increased fracture risk compared with controls (106 of 660, 16.06%) (p = 0.02). Logistic regression analysis showed that age (OR 2.17; 95% CI 1.27–4.00), glucocorticoids (OR 3.83; 95% CI 1.32–14.09) and falls (OR 3.57; 95% CI 1.91–6.86) were the independent predictors of vertebral fractures in RA patients. The subgroup with vertebral fractures had higher disease activity (DAS28: 3.15 vs. 2.78, p = 0.038) and disability (HAQ: 0.96 vs. 0.63, p = 0.049), as compared with those without vertebral fractures.

Conclusion

The risk of vertebral fracture in RA is still high in recent years, when compared with the general population. The key determinants of fracture risk are age, glucocorticoids and falls. Patients with vertebral fractures have a more severe RA.

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Funding

This study is funded in part by a grant from the Instituto de Salud Carlos III (PI18/00762), Ministerio de Economia y Competitividad, Spain, that included FEDER funds from the EU.

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Correspondence to N. Guañabens.

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Conflicts of interest

Dr. Guañabens has in the past received fees for lectures and/or advice from Alexion, Amgen, Eli Lilly and UCB. Dr. Olmos has received in the past fees for lectures from Amgen, Eli Lilly, Stada and Gedeon-Richter. Dr. Hernandez received grant funding and fees for lectures from AMGEN and MSD. Dr. Naranjo has in the past received fees for lectures and/or advice from Amgen and UCB. Dr. Castañeda has received fees for lectures and/or advice from Amgen, Eli Lilly, MSD, Novartis, Roche, Stada and UCB. Dr. Castellanos-Moreira has in the past received fees for lectures and/or advice from Pfizer, Lilly, UCB and BMS. The remaining authors have no competing interests to disclose.

Ethical approval

The study was approved by the Ethics Committee of the University Hospital of Bellvitge, Catalonia, Spain.

Informed consent

All RA patients provided a written informed consent to participate.

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Key messages

• The risk of vertebral fracture is currently higher in rheumatoid arthritis than in the general population.

• Independent variables for vertebral fractures in rheumatoid arthritis are age, treatment with glucocorticoids and falls.

• RA patients with vertebral fractures have higher disease activity and greater disability than those without fractures.

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Guañabens, N., Olmos, J.M., Hernández, J.L. et al. Vertebral fractures are increased in rheumatoid arthritis despite recent therapeutic advances: a case-control study. Osteoporos Int 32, 1333–1342 (2021). https://doi.org/10.1007/s00198-021-05824-7

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  • DOI: https://doi.org/10.1007/s00198-021-05824-7

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