The association between 10-year fracture risk by FRAX and osteoporotic fractures with disease activity in patients with rheumatoid arthritis


As rheumatoid arthritis (RA) is an independent risk factor for osteoporotic fractures, the severity of disease activity may correlate with fracture risk. Our objectives were to determine the prevalence of major osteoporotic and hip fractures in patients with RA and to identify the factors related to their 10-year probabilities. This study enrolled 232 patients with RA, aged 40–90 years, who participated in the Siriraj RA Cohort in 2016 and 2017. Demographic data, disease activity scores 28 (DAS28), and health assessment questionnaires (HAQ) were collected. All participants were evaluated for asymptomatic vertebral fractures by thoracolumbar spine radiography. The osteoporotic fracture risks were determined using the fracture risk assessment tool (FRAX). Most subjects were postmenopausal women in their sixth decade; the median disease duration was 12.95 years. Forty-six percent of patients had osteoporotic fractures, and most (87%) were vertebral fractures. Eighty-one patients had asymptomatic vertebral compression fractures. Of those, 57%, 25%, and 18% had low, moderate, and high 10-year probabilities of major osteoporotic fractures, respectively, while 51%, 34%, and 15% had low, moderate, and high 10-year probabilities of hip fractures, respectively. Factors significantly associated with the 10-year probabilities of major osteoporotic and hip fractures were disease duration (p 0.017, 0.009), menopause duration (p < 0.001 both), cumulative disease activity (DAS28; p 0.004, 0.029), and cumulative functional disability (HAQ; p < 0.001 both). Moderate to high 10-year probabilities of major osteoporotic and hip fractures are common in RA. Cumulative disease severity is a high risk for osteoporotic fractures.

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We thank Ms. Wanwisa Chanapai, BSc (Nursing), and Mrs. Kamolnate Chareonhongthong, BSc (Nursing), MSc (Public Health), for data collection and management; Ms. Khemajira Karaketklang, BSc (Nursing), M.P.H., for statistical analysis; and Assistant Professor Dr. Ajchara Koolvisoot and Dr. Pongthorn Narongroeknawin for their advice.


This study was funded by the Siriraj Research Grant Number Si255/2016 and the Thai Rheumatism Association Grant Number F1/2559.

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Corresponding author

Correspondence to Wanruchada Katchamart.

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This study was conducted in accordance with the ethical principles of the Declaration of Helsinki and adhered to the principles outlined in the Guideline for Good Clinical Practice International Conference on Harmonization (ICH) Tripartite Guideline (January 1997). The study protocol was approved by local ethics committee, the Siriraj institutional review board.



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Phuan-udom, R., Lektrakul, N. & Katchamart, W. The association between 10-year fracture risk by FRAX and osteoporotic fractures with disease activity in patients with rheumatoid arthritis. Clin Rheumatol 37, 2603–2610 (2018).

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  • 10-year probability of fracture
  • Fracture risk assessment
  • FRAX
  • Osteoporosis
  • Rheumatoid arthritis