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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Engel A, Roberts J, Burch TA (1966) Rheumatoid arthritis in adults. Vital Health Stat 11:1–43
Mikkelsen WM, Dodge HJ, Duff IF, Kato H (1967) Estimates of the prevalence of rheumatic diseases in the population of Tecumseh, Michigan, 1959-60. J Chronic Dis 20:351–369. https://doi.org/10.1016/0021-9681(67)90009-4
Wolfe AM (1968) The epidemiology of rheumatoid arthritis: a review. I. Surveys. Bull Rheum Dis 19:518–523
Chaiamnuay P, Darmawan J, Muirden KD, Assawatanabodee P (1998) Epidemiology of rheumatic disease in rural Thailand: a WHO-ILAR COPCORD study. Community oriented programme for the control of rheumatic disease. J Rheumatol 25:1382–1387
Wolfe F, Mitchell DM, Sibley JT, Fries JF, Bloch DA, Williams CA, Spitz PW, Haga M, Kleinheksel SM, Cathey MA (1994) The mortality of rheumatoid arthritis. Arthritis Rheum 37:481–494
Gabriel SE, Michaud K (2009) Epidemiological studies in incidence, prevalence, mortality, and comorbidity of the rheumatic diseases. Arthritis Res Ther 11:229. https://doi.org/10.1186/ar2669
Dougados M, Soubrier M, Antunez A, Balint P, Balsa A, Buch MH, Casado G, Detert J, el-zorkany B, Emery P, Hajjaj-Hassouni N, Harigai M, Luo SF, Kurucz R, Maciel G, Mola EM, Montecucco CM, McInnes I, Radner H, Smolen JS, Song YW, Vonkeman HE, Winthrop K, Kay J (2014) Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA). Ann Rheum Dis 73:62–68
(1991) Consensus development conference: prophylaxis and treatment of osteoporosis. Am J Med 90:107–110
Kanis JA, Melton LJ 3rd, Christiansen C et al (1994) The diagnosis of osteoporosis. J Bone Miner Res 9:1137–1141. https://doi.org/10.1002/jbmr.5650090802
Haugeberg G, Uhlig T, Falch JA, Halse JI, Kvien TK (2000) Bone mineral density and frequency of osteoporosis in female patients with rheumatoid arthritis: results from 394 patients in the Oslo County Rheumatoid Arthritis register. Arthritis Rheum 43:522–530
Kim SY, Schneeweiss S, Liu J, Daniel GW, Chang CL, Garneau K, Solomon DH (2010) Risk of osteoporotic fracture in a large population-based cohort of patients with rheumatoid arthritis. Arthritis Res Ther 12:R154. https://doi.org/10.1186/ar3107
Haugeberg G, Orstavik RE, Kvien TK (2003) Effects of rheumatoid arthritis on bone. Curr Opin Rheumatol 15:469–475
Goldring SR, Gravallese EM (2000) Mechanisms of bone loss in inflammatory arthritis: diagnosis and therapeutic implications. Arthritis Res 2:33–37
Rossini M, Viapiana O, Adami S, Fracassi E, Idolazzi L, Dartizio C, Povino MR, Orsolini G, Gatti D (2015) In patients with rheumatoid arthritis, Dickkopf-1 serum levels are correlated with parathyroid hormone, bone erosions and bone mineral density. Clin Exp Rheumatol 33:77–83
Rossini M, Bagnato G, Frediani B et al (2011) Relationship of focal erosions, bone mineral density, and parathyroid hormone in rheumatoid arthritis. J Rheumatol 38:997–1002
Geraci A (2012) Osteoporosis in rheumatoid arthritis. Available from: http://www.intechopen.com/books/insights-and-perspectives-in-rheumatology/osteoporosis-in-rheumatoidarthritis
Kanis JA, Oden A, Johnell O, Johansson H, de Laet C, Brown J, Burckhardt P, Cooper C, Christiansen C, Cummings S, Eisman JA, Fujiwara S, Glüer C, Goltzman D, Hans D, Krieg MA, la Croix A, McCloskey E, Mellstrom D, Melton LJ, Pols H, Reeve J, Sanders K, Schott AM, Silman A, Torgerson D, van Staa T, Watts NB, Yoshimura N (2007) The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int 18:1033–1046
Briot K, Paternotte S, Kolta S, Eastell R, Felsenberg D, Reid DM, Glüer CC, Roux C (2013) FRAX®: prediction of major osteoporotic fractures in women from the general population: the OPUS Study. PLoS One 8:e83436. https://doi.org/10.1371/journal.pone.0083436
Indhavivadhana S, Rattanachaiyanont M, Angsuwathana S, Techatraisak K, Tanmahasamut P, Leerasiri P (2016) Validation of osteoporosis risk assessment tools in middle-aged Thai women. Climacteric 19:588–593. https://doi.org/10.1080/13697137.2016.1231176
Kanis JA, McCloskey EV, Johansson H et al (2010) Development and use of FRAX in osteoporosis. Osteoporos Int 21(Suppl 2):S407–S413
Brown JP, Josse RG, Canada TSAC of the OS of (2002) (2002) Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ 167:s1–s34
Resnick D, Kransdorf MJ (2005) Bone and joint imaging. Elsevier Saunders
van Riel PLCM, Ralph Schumacher Jr H (2001) How does one assess early rheumatoid arthritis in daily clinical practice? Best Pract Res Clin Rheumatol 15:67–76. https://doi.org/10.1053/berh.2000.0126
Vander Cruyssen B, Van Looy S, Wyns B et al (2005) DAS28 best0020reflects the physician’s clinical judgment of response to infliximab therapy in rheumatoid arthritis patients: validation of the DAS28 score in patients under infliximab treatment. Arthritis Res Ther 7:R1063–R1071. https://doi.org/10.1186/ar1787
Prevoo MLL, Van’T Hof MA, Kuper HH et al (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 38:44–48. https://doi.org/10.1002/art.1780380107
Osiri M, Deesomchok U, Tugwell P (2001) Evaluation of functional ability of Thai patients with rheumatoid arthritis by the use of a Thai version of the Health Assessment Questionnaire. Rheumatology (Oxford) 40:555–558
Ibanez D, Urowitz MB, Gladman DD (2003) Summarizing disease features over time: I. Adjusted mean SLEDAI derivation and application to an index of disease activity in lupus. J Rheumatol 30:1977–1982
Coulson KA, Reed G, Gilliam BE, Kremer JM, Pepmueller PH (2009) Factors influencing fracture risk, T score, and management of osteoporosis in patients with rheumatoid arthritis in the Consortium of Rheumatology Researchers of North America (CORRONA) registry. J Clin Rheumatol 15:155–160. https://doi.org/10.1097/RHU.0b013e3181a5679d
Furuya T, Kotake S, Inoue E, Nanke Y, Yago T, Kobashigawa T, Ichikawa N, Tanaka E, Momohara S, Nakajima A, Hara M, Tomatsu T, Yamanaka H, Kamatani N (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 34:303–310
Sinigaglia L, Nervetti A, Mela Q 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 27:2582–2589
Mohammad A, Lohan D, Bergin D, Mooney S, Newell J, O'Donnell M, Coughlan RJ, Carey JJ (2014) The prevalence of vertebral fracture on vertebral fracture assessment imaging in a large cohort of patients with rheumatoid arthritis. Rheumatology (Oxford) 53:821–827
Orstavik RE, Haugeberg G, Uhlig T et al (2004) Self reported non-vertebral fractures in rheumatoid arthritis and population based controls: incidence and relationship with bone mineral density and clinical variables. Ann Rheum Dis 63:177–182
Furuya T, Hosoi T, Saito S, Inoue E, Taniguchi A, Momohara S, Yamanaka H (2011) Fracture risk assessment and osteoporosis treatment disparities in 3,970 Japanese patients with rheumatoid arthritis. Clin Rheumatol 30:1105–1111. https://doi.org/10.1007/s10067-011-1748-8
Meng J, Li Y, Yuan X, Lu Y (2017) Evaluating osteoporotic fracture risk with the Fracture Risk Assessment Tool in Chinese patients with rheumatoid arthritis. Medicine (Baltimore) 96:e6677. https://doi.org/10.1097/MD.0000000000006677
Orsolini G, Caimmi C, Viapiana O et al (2017) AB0216 Effects of anti-citrullinated protein antibodies on systemic bone mass in rheumatoid arthritis patients. Ann Rheum Dis 76:1124
El Maghraoui A, Sadni S, Jbili N et al (2014) The discriminative ability of FRAX, the WHO algorithm, to identify women with prevalent asymptomatic vertebral fractures: a cross-sectional study. BMC Musculoskelet Disord 15:365. https://doi.org/10.1186/1471-2474-15-365
Méndez C, Silva L, Andreu JL et al (2013) AB0215 Risk markers of morphometric vertebral fracture in rheumatoid arthritis. Ann Rheum Dis 72:A852
Rentero ML, Amigo E, Chozas N et al (2015) Prevalence of fractures in women with rheumatoid arthritis and/or systemic lupus erythematosus on chronic glucocorticoid therapy. BMC Musculoskelet Disord 16:300. https://doi.org/10.1186/s12891-015-0733-9
El Maghraoui A, Rezqi A, Mounach A et al (2010) Prevalence and risk factors of vertebral fractures in women with rheumatoid arthritis using vertebral fracture assessment. Rheumatology 49:1303–1310
Wong CC, McGirt MJ (2013) Vertebral compression fractures: a review of current management and multimodal therapy. J Multidiscip Healthc 6:205–214. https://doi.org/10.2147/JMDH.S31659
Kanis JA, McCloskey E, Johansson H, Oden A, Leslie WD (2012) FRAX® with and without bone mineral density. Calcif Tissue Int 90:1–13
Olmez Sarikaya N, Kapar Yavasi S, Tan G, Satiroglu S, Yildiz AH, Oz B, Yoleri O, Memis A (2014) Agreement between FRAX scores calculated with and without bone mineral density in women with osteopenia in Turkey. Clin Rheumatol 33:1785–1789. https://doi.org/10.1007/s10067-014-2491-8
Kim JW, Koh J-M, Park JH, Chang JS (2015) Validation of FRAX without BMD: an age-related analysis of the Fifth Korean National Health and Nutrition Examination Survey (KNHANES V-1, 2010). Bone 75:27–31. https://doi.org/10.1016/j.bone.2015.02.013
Bastos-Silva Y, Aguiar LB, Pinto-Neto AM, Baccaro LF, Costa-Paiva L (2016) Correlation between osteoporotic fracture risk in Brazilian postmenopausal women calculated using the FRAX with and without the inclusion of bone densitometry data. Arch Osteoporos 11:16. https://doi.org/10.1007/s11657-015-0255-y
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.
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.
About this article
Cite this article
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). https://doi.org/10.1007/s10067-018-4218-8
- 10-year probability of fracture
- Fracture risk assessment
- Rheumatoid arthritis