Analytical Study of the Risk Factors Affecting the Fracture Risk in Rheumatoid arthritis Patients using FRAX...

The present study aimed to calculate the risk of osteoporotic fracture in patients of Rheumatoid arthritis (RA) by Fracture Risk Assessment Tool (FRAX) and its relationship with osteoporotic-specific risk factors.

This was a observational cross-sectional analytical study conducted from January 2019 to September 2020 where 185 patients, aged 40-90 years, who presented to the Rheumatology Clinic meeting the ACR/EULAR (2010) Classification Criteria for Rheumatoid Arthritis were included in the study and matched with 185 healthy individuals. We assessed the severity of the disease by using the DAS28 score. In addition, we evaluated the FRAX algorithm for all patients and controls to determine the 10-year fracture risk of major osteoporotic fracture and hip fracture.

RA patients had a significantly higher mean 10-year risk of major osteoporotic fracture (4.77 ± 5.04 vs 2.05 ± 1.84, P<0.05) and significantly higher mean 10-year risk of hip fracture (1.71 ± 2.81 vs 0.5 ± 0.95) (p<0.05).There was a significant positive correlation of duration of disease, previous fracture; parent fractured hip with major osteoporotic fracture (r=0.257, 0.435, 0.169 respectively) and with hip fracture (r=0.26, 0.369, 0.212 respectively). We saw no correlation of fracture risk with ESR (mm/hr), DAS28, CRP (mg/dL), glucocorticoid use, smoking, and alcohol use.

The risk of hip fracture and major osteoporotic fracture significantly increased in both male and female patients with RA as assessed by the FRAX algorithm. Duration of the disease, previous fracture, and parent fracture hip showed a significant correlation with major osteoporotic fracture and hip fracture. Therefore, the early recognition and treatment of RA hold importance in reducing the fracture risk.