Background/Purpose: Cardiovascular disease(CVD) represents a major comorbidity and the leading cause of mortality for Rheumatoid arthritis(RA) patients. Unfortunately traditional risk factors for CVD underperform in RA. Enhanced risk stratification methods are needed. Recently a strong association between osteoporosis and CVD has been recognised in other populations. RA patients are also at increased risk of osteoporosis and thus may undergo DXA scanning as part of their usual care. DXA can diagnose osteoporosis by measuring BMD or by detecting vertebral fractures(VF) using VFA. We assessed the prevalence of osteoporosis by BMD criteria and VF in our RA cohort. We also determined whether osteoporosis increases the risk of CVD in RA patients compared to traditional CVD risk factors and RA disease activity.

Methods: A cross-sectional study of our RA cohort. We evaluated risk factors for, and details of CVD among patients ≥40 years who met 1987 ACR criteria for RA classification. Only those with a prior DXA and VFA scan available for analysis were included. Study was approved by local I.R.B. All scans were evaluated by two blinded musculoskeletal radiologists to determine the prevalence, number and severity of VF using Genant criteria. Patients were diagnosed as ‘osteoporosis’ using WHO DXA criteria. We compared the prevalence of osteoporosis and VF between RA patients with and without CVD, and using multivariate logistic regression analyses assessed whether VF, osteoporosis, traditional CVD risk factors and RA disease activity were independently associated with prevalent CVD.

Results: 603 patients met inclusion criteria: 74% female mean age 56 years, 76% seropositive. 230 subjects had 1 or more documented CVD event: MI 45, stent 145, CHF 33 and stroke 7. Subjects with CVD were twice as likely to have VF (24% Vs 12%) and 4 times as likely to have osteoporosis (60% Vs 15%) than those without CVD(p <0.05). Low BMD and VF were independently associated with CVD in multivariate regression analyses (P <0.05), and outperformed traditional risk factors for CVD and RA disease activity scores (Table 1). 

Conclusion: BMD and VF among RA patients should alert physicians not just to the presence of osteoporosis, but also to the possibility of CVD. Interventions to reduce the development of CVD in RA patients with osteoporosis may be warranted. 

Table 1: Age/gender adjusted OR for Osteoporosis, VF, RA Disease Activity and Traditional CVD Risk factors for CVD in RA Cohort                      

Variable	OR (95% Confidence Interval)	p Value
Diabetes Mellitus Smoking Hypertension Hyperlipidemia CRP DAS28 Vertebral fracture Osteoporosis	1.61 (1.04-2.48) 1.18 (1.10-1.27) 1.58 (1.12-1.89) 1.02 (1.00-1.05) 1.73 (1.41-2.12) 1.63 (1.30-2.03) 2.70 (1.50-4.75) 2.67 (1.87-3.91)	<0.001 0.042 0.001 0.041 <0.001 0.001 <0.001 <0.001

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/osteoporosis-and-vertebral-fractures-are-important-determinants-of-cardiovascular-disease-in-rheumatoid-arthritis/