Risk of Osteoporosis and Degraded Trabecular Bone Score in Rheumatoid Arthritis Patients

Patients with rheumatoid arthritis (RA) are at an increased risk of developing osteoporosis and fractures, particularly when treated with glucocorticoids. Trabecular bone score (TBS) is a valuable complementary tool for evaluating bone microarchitecture, enhancing the prediction of fracture risk beyond bone mineral density (BMD).

To determine factors associated with osteoporosis and degraded TBS in RA patients.

A cross-sectional study was conducted on 131 RA patients treated at Nguyen Tri Phuong Hospital. BMD and TBS were evaluated according to Asian reference standards; osteoporosis was defined according to WHO criteria and TBS was categorized using two cut-off points of < 1.23 (degraded) and 1.32 (normal). General risk factors and RA-specific factors were analyzed using univariate analysis, followed by multivariate logistic regression to identify factors associated with osteoporosis (T-score ≤ -2.5) and degraded TBS (< 1.23).

Osteoporosis was identified in 22.1% of patients, while more patients (26%) exhibited degraded TBS. Combining BMD with TBS identified 32.8% of patients as high risk. Factors associated with osteoporosis included advanced age (OR = 1.05, p = 0.05), lower body weight (OR = 0.94, p = 0.02), and sarcopenia (OR = 2.99, p = 0.08). Degraded TBS was significantly associated with older age (OR = 1.13, p < 0.005) and structural RA-associated bone damage (OR = 2.50, p = 0.09).

The study highlights that advanced age, low body weight, and sarcopenia are key factors associated with osteoporosis in RA patients. Similarly, older age and RA-associated structural damage, are associated with degraded TBS. The combination of BMD and TBS is recommended for bone health assessment in rheumatoid arthritis patients.