Background/Purpose:

Rheumatoid arthritis (RA) and early menopause (<45 years) are recognised risk factors for the development of osteoporosis and form part of the World Health Organisation “FRAX” 10-year fracture risk-stratification tool^[1]. It is not known whether age of menopause is an independent risk factor for osteoporosis in women with RA. Evidence exists linking connective tissue diseases to earlier menopause^[2]however whether this also occurs in RA is unknown.

This paper aims to establish whether RA is associated with earlier menopause and whether age of menopause is an independent risk factor for osteoporosis in RA.

Methods:

Data from female patients with RA attending for dual-energy X-ray absorptiometry (DXA) assessment between 2004 and 2011 was analysed using a nested case-control approach. Control subjects with no pre-defined indication for DEXA assessment were age-matched with RA subjects. Osteoporosis was defined as any hip or lumbar spine (L1-L4) T-score <-2.5.  Student’s t-test was used to compare age of menopause in the RA and control group. Subjects were divided into 3 tertiles according to age of menopause and logistic regression performed to assess for relationships with osteoporosis. All statistical analysis was performed using STATA v11.2, with results expressed as odds ratios (OR) with 95% confidence intervals (95%CI). P values <0.05 were considered significant.

Results:

397 subjects (median age 69.5 years, interquartile range 62.1,76.5) were matched for age with 397 controls. Mean age of menopause was lower in RA subjects (48.1 years vs. 49.7 years, mean difference 1.6 years) and was significant (p<0.001). After adjusting for age the earliest menopause tertile (median age of menopause 43.9 years) was associated with the highest odds of osteoporosis (OR 1.65 95%CI 1.13,2.41 p=0.01). Odds were increased to a lesser degree in the second-earliest tertile (median menopause age 50.2 years, OR 1.48 95%CI 1.00,2.17 p=0.048). No such associations were seen in controls.

Conclusion:

This case-control study has demonstrated for the first time that women with RA experience the menopause earlier, and that earlier age of menopause is an independent risk factor for the development of osteoporosis in this population.

References:

1. FRAX tool: http://www.shef.ac.uk/FRAX/index.aspx
2. Ekblom-Kullberg S. et al “Reproductive health in women with systemic lupus erythematosus compared to population controls.” Scandinavian Journal of Rheumatology. 2009;38(5): 375-380

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/menopause-occurs-earlier-and-is-an-independent-risk-factor-for-osteoporosis-in-women-with-rheumatoid-arthritis/