Fracture risk assessment and osteoporosis treatment disparities in 3,970 Japanese patients with rheumatoid arthritis
The aims of this study are to determine the proportion of patients at high risk for major osteoporotic and hip fractures in a Japanese cohort with rheumatoid arthritis (RA) and to determine if a care gap exists for high-risk patients. The Fracture Risk Assessment Tool (FRAX®) was administered to 3,970 Japanese patients with RA enrolled in the Institute of Rheumatology Rheumatoid Arthritis cohort study with (n = 276) and without (n = 3,694) the use of bone mineral density (BMD) measurement. The study population had a mean age of 62 years and was 84% female. Among the 1,522 patients ≥65 years of age, 661 (43%) and 1,304 (86%) were at high risk for a major osteoporotic fracture (10-year probability >20%) and hip fracture (>3%), respectively. Among patients at high risk for a major osteoporotic fracture (n = 723), only 453 (63%) and 320 (44%) reported taking any osteoporosis medications and bisphosphonates, respectively. Among female patients with BMD measurements (n = 262), the 10-year risk of a major osteoporotic fracture calculated with BMD was significantly higher than in those without BMD measurements (P < 0.001). The FRAX identified a substantial proportion of elderly Japanese RA patients with a high risk of fractures. A substantial gap exists between fracture risk and osteoporosis treatment in Japanese RA patients, as previously reported for patients of other ethnicities. In addition, the gap may be underestimated when BMD measurements are not involved in the fracture risk assessment.
KeywordsBone mineral density Fracture FRAX® Japanese Osteoporosis Rheumatoid arthritis
We thank all members of the Institute of Rheumatology, Tokyo Women's Medical University for the successful management of the IORRA cohort and Dr. R. L. Wilder for his useful suggestions. The IORRA cohort was supported by nonrestricted research grants from 37 pharmaceutical companies: Abbott Japan Co., Ltd.; Asahikasei Kuraray Medical Co., Ltd.; Asahikasei Pharma Corporation; Astellas Pharma Inc.; AstraZeneca K.K.; Banyu Pharmaceutical Co., Ltd.; Chugai Pharmaceutical Co., Ltd.; Daiichi Fine Chemical Co., Ltd.; Daiichi Sankyo Co., Ltd.; Dainippon Sumitomo Pharma Co., Ltd.; Eisai Co., Ltd.; GlaxoSmithKline K.K.; Janssen Pharmaceutical K.K.; Japan Tobacco Inc.; Kaken Pharmaceutical Co., Ltd.; Kissei Pharmaceutical Co., Ltd.; Kowa Pharmaceutical Co., Ltd.; Mitsubishi Chemical Medience Corporation; Mitsubishi Tanabe Pharma Corporation; Mundipharma K.K.; Nippon Chemiphar Co., Ltd.; Nippon Shinyaku Co., Ltd.; Novartis Pharma K.K.; Otsuka Pharmaceutical Co., Ltd.; Pfizer Japan Inc.; Sanofi-Aventis K.K.; Santen Pharmaceutical Co., Ltd.; Sanwa Kagaku Kenkyusho Co., Ltd.; Sekisui Medical Co., Ltd.; Taisho Toyama Pharmaceutical Co., Ltd.; Takeda Pharmaceutical Company Limited; Teijin Pharma Limited; Torii Pharmaceutical Co., Ltd.; Toyama Chemical Co., Ltd.; UCB Japan Co., Ltd.; Wyeth K.K.; and Zeria Pharmaceutical Co., Ltd. This work was also supported in part by a grant from the Japan Osteoporosis Society.
HY received research grants from Chugai Pharmaceutical Co., Ltd.; Astellas Pharma Inc.; Wyeth; Daiichi-Sankyo; Banyu Pharmaceutical Co., Ltd.; Tanabe-Mitsubishi; Abbott; Eisai; Santen Pharmaceutical Co., Ltd.; Taisyo-Toyama Pharmaceutical Co., Ltd.; Takeda Pharmaceutical Co; Kissei Pharmaceutical Co., Ltd.; and Janssen Pharmaceutical K.K. HY received lecture fees from Abbott, Eisai, Takeda Pharmaceutical Co., Tanabe-Mitsubishi, Janssen Pharmaceutical K.K., Hoffmann-La Roche, and Chugai Pharmaceutical Co., Ltd. The others have no conflicts of interest.
- 5.Furuya T, Kotake S, Inoue E, Nanke Y, Yago T, Kobashigawa T, Ichikawa N, Tanaka E, Momohara S, Nakajima A et al (2007) Risk factors associated with incident clinical vertebral and nonvertebral fractures in Japanese women with rheumatoid arthritis: a prospective 54-month observational study. J Rheumatol 34:303–310PubMedGoogle Scholar
- 6.Furuya T, Urano T, Ikari K, Kotake S, Inoue S, Hara M, Momohara S, Kamatani N, Yamanaka H (2009) A1330V polymorphism of low-density lipoprotein receptor-related protein 5 gene and self-reported incident fractures in Japanese female patients with rheumatoid arthritis. Mod Rheumatol 19:140–146PubMedCrossRefGoogle Scholar
- 8.Urano W, Furuya T, Inoue E, Taniguchi A, Urano T, Kotake S, Sekita C, Inoue S, Hara M, Momohara S et al (2009) Associations between methotrexate treatment and methylenetetrahydrofolate reductase gene polymorphisms with incident fractures in Japanese female rheumatoid arthritis patients. J Bone Miner Metab 27:574–583PubMedCrossRefGoogle Scholar
- 11.Grossman JM, Gordon R, Ranganath VK, Deal C, Caplan L, Chen W, Curtis JR, Furst DE, McMahon M, Patkar NM et al (2010) American College of Rheumatology 2010 recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Care Res (Hoboken) 62:1515–1526CrossRefGoogle Scholar
- 20.Prevoo ML, van't Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL (1995) Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 38:44–48PubMedCrossRefGoogle Scholar
- 23.Sinigaglia L, Nervetti A, Mela Q, Bianchi G, Del Puente A, Di Munno O, Frediani B, Cantatore F, Pellerito R, Bartolone S et al (2000) A multicenter cross sectional study on bone mineral density in rheumatoid arthritis. Italian Study Group on Bone Mass in Rheumatoid Arthritis. J Rheumatol 27:2582–2589PubMedGoogle Scholar