Background/Purpose: Erosive hand osteoarthritis (ErHOA) is a severe form of hand osteoarthritis (HOA) characterized by greater inflammation and higher burden of disease. In this more inflammatory form of HOA, we wanted to explore bone loss and fracture

Methods: We used data from the prospective QUALYOR study that enrolled 1575 postmenopausal women, aged at least 55 years, followed prospectively for 12 years.At the 5-year visit (baseline of this work), we evaluated HOA using hand radiographs and clinical examination. HOA status was defined as follows: – No HOA : no pain AND no radiographic sign- Radiographic HOA (RxHOA) : at least 2 joints graded KL ≥ 2 AND no symptoms- Symptomatic HOA (SyHOA) : ACR criteria for HOA (no eroded joints)- Erosive HOA (ErHOA) : SyHOA with at least one eroded jointOsteoporotic (OP) status was evaluated at the 5-year visit by DXA (BMD at lumbar spine and hip) and history of fractures (medically confirmed) was recorded. Incident OP fractures at each subsequent follow-up visit were medically ascertained. OP status was defined as follows:- No OP: All T-scores above -2.5 AND no history of OP fractures- OP DXA: At least one T-score bellow -2.5 AND no history of OP fracture- OP fracture: History of at least one OP fracture (regardless of T-scores)We investigated the association between HOA status and incidence of OP fractures using a Cox model with adjustment for age, history of fractures, T-scores and obesity. Kaplan Meier curves representing survival without incident fractures were obtained according to HOA status. We also conducted a subgroup analysis stratifying patient by prevalent fracture at baseline combined with HOA status.

Results: We have analyzed data from 1180 patients. The mean age was 71.7(± 6.41) years and the mean follow-up time was 4.6 (±0.85) years. Among them, 364 (30.8%) had no HOA, 335 (28.4%) had RxHOA, 340 (28.8%) had SyHOA and 141 (11.9%) had ErHOA. Patients with HOA were older than patients without HOA (Table 1)During follow-up, 131 patients (11.1%) experienced 166 incident OP fractures with a mean follow-up time to event of 2.2 (±1.42) years. Patients with incident OP fractures were older and had lower BMD. Among them 19.1% had ErHOA compared to 11.1% in those without incident OP fracture (p< 0.05). Kaplan-Meier curves depicting the survival without incident fracture according to HOA status is provided in Figure 2. The HR for incident fracture in patients with ErHOA compared to patients without HOA was 1.93 (CI95% 1.12-3.32, p< 0.05), whereas the HR was 1.1 (CI95% 0.69-1.77) for SyHOA and HR 0.95 (CI95% 0.59-1.57) for RxHOA compared with patients without HOA.Patients with ErHOA and no history of OP fracture had an increased risk of incident fractures with a HR of 1.95 (CI95% 1.07-3.5, p< 0.05) compared to patient without HOA and no history of fracture. Of note, patients without HOA but prevalent OP fracture – a recognized strong risk factor for fracture – had a HR of 1.41 (CI95% 0.62-3.23) when compared with those without prevalent fracture.

Conclusion: In conclusion, erosive HOA is a strong predictor of incident osteoporotic fracture, in postmenopausal women, independently of various classical risk factors for fracture. Exploring the sources of bone loss distinguishing erosive HOA from other types of HOA is warranted.

Figure 1. Study design

Table 1. Characteristics of the total population and according to HOA status

Figure 2. Kaplan-Meier curves representation the survival without incident fracture according to HOA status

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/erosive-hand-osteoarthritis-is-associated-with-increased-risk-of-incident-osteoporotic-fractures-in-post-menopausal-women-qualyor-cohort/