OC14 - HIGH INCIDENCE OF VERTEBRAL AND NON-VERTEBRAL FRACTURES IN THE OSTRA-COHORT STUDY: A 5 YEAR FOLLOW-UP STUDY IN POSTMENOPAUSAL WOMEN WITH RHEUMATOID ARTHRITIS
M. Vis1, E. Haavardsholm2, P. Bøyesen2, G. Haugeberg3, T. Uhlig2, M. Hoff4, A. Woolf5, B. Dijkmans1, W. Lems1, T. Kvien2
1Rheumatology, VU university medical center, Amsterdam, Netherlands, 2Rheumatology, Diakonhjemmet Hospital, Oslo, Norway, 3Rheumatology, Sørlandet Hospital, Kriastansand, Norway, 4Rheumatology, St. Olavs Hospital, NTNU, Trondheim, Norway, 5Rheumatology, Royal Cornwall Hospital, Truro, United Kingdom
Abstract: Introduction: Osteoporosis is a well-known extra-articular feature of rheumatoid arthritis (RA). There are however only scarce longitudinal data on fractures in RA patients. Therefore we undertook this study to investigate the incidence of vertebral and non-vertebral fractures over a 5 years period in a cohort of postmenopausal patients with established rheumatoid arthritis (RA). Methods: 150 female patients with established RA were included into the OSTRA cohort.1 The cohort was assessed at baseline and at 5 years with spinal X-rays. Spinal X-rays were scored using the semi-quantitative method according to the Genant-method. After 5 years, 102 patients (68%) were examined at follow-up and included in the present analyses. Results: At baseline, the mean age was 61 years, disease duration 17 years, and 66% of the patients were rheumatoid factor positive. Fifteen percent of patients were treated with bisphosphonates, 25% received calcium supplementation and 20% vitamin-D supplementation at baseline. During follow-up the mean disease activity score (DAS-28) decreased from 5.4 (1.3) to 3.6 (1.2). Most patient were treated with modern regimens; 65% of patients used methotrexate and 20% were using a TNF blocker.
During 5-years follow-up a total of 16 patients out of 102 patients had a new non vertebral fracture (15.6 %), annual incidence of 3.2 (95% CI: 1.8-5.5 per 100 patients) . In eighteen patients out of 97 patients (18.5%), new vertebral fractures were identified on x-rays (annual incidence of 3.7 (95% C.I. 2.2-5.8) per 100 patients years).
In the multivariate logistic analysis, we identified BMD at the total-hip as an independent predictor for incident non-vertebral fractures and non-vertebral fractures at baseline were an independent predictor of new vertebral fractures. Conclusions: We found a high incidence of vertebral and non vertebral fractures in a cohort of women with established RA compared to population based studies, which is remarkable, since moste patients were treated with modern antirheumatic treatment.
For example in the EPOS study, in which fractures were observed in a general population of 50 years and older, the annual incident of morphometric vertebral fractures in females was 1.07 per 100 patient years and non-vertebral fractures 1.9 per 100 patient years.2,3
1. Haugeberg G, et al, Arthritis Rheum 43:522-530.
2. EPOS study group, J Bone Miner Res 17:716-24
3. Ismail AA, Osteoporos Int; 13:565-7
Disclosure of Interest: None declared
Keywords: fractures, rheumatoid arthrtis, vertebral fractures
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