Risk Factors for Vertebral Fractures in Patients with Rheumatoid Arthritis – the Tomorrow Study

Tadashi Okano¹, Tatsuya Koike², Masahiro Tada¹, Kenji Mamoto³, Yuko Sugioka¹, Atsuko Kamiyama⁴ and Hiroaki Nakamura¹, ¹Orthopedic Surgery, Osaka City University Medical School, Osaka, Japan, ²Center for Senile Degenerative Disorders (CSDD), Osaka City University Medical School, Osaka, Japan, ³Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan, ⁴Rheumatosurgery, Osaka City University Medical School, Osaka, Japan

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: Bone density, bone metabolism, fractures, Osteoporosis and rheumatoid arthritis (RA)

Session Information

Title: Osteoporosis and Metabolic Bone Disease

Session Type: Abstract Submissions (ACR)

Background/Purpose:

Rheumatoid arthritis (RA) is one of the causes for secondary osteoporosis. Osteoporosis as a multifactorial disease might be derived from comorbidity itself, poorer physical activity, treatment with glucocorticoids, or postmenopausal status. Accelerated generalized bone loss often leads to an increased risk of vertebral fractures. The purpose of this study is to determine the prevalence and the risk factors for vertebral fractures in patients with RA.

Methods:

We started a 10-year prospective cohort study named TOMORROW (TOtal Management Of Risk factors in Rheumatoid arthritis patients to lOWer morbidity and mortality, clinical trial registration number: UMIN000003876) in 2010. This study included 208 patients with RA (biological agents, n = 112; conventional therapy, n = 96) and 205 age- and sex-matched volunteers (total, n = 413). We evaluated the prevalence of vertebral fractures using thoracolumbar spine X-rays and analyzed the factors associated with vertebral fractures. Evaluation of existing vertebral fractures was used for a quantitative assessment of each vertebra from T4 to L4 as a first assessment and a semiquantitative visual assessment of each vertebra considered existing vertebral fractures by first assessment.

Results:

The prevalence of vertebral fractures was 45.5% and 30% in the RA and volunteer groups, respectively. Significantly more RA patients than volunteers had semiquantitative (SQ) grade 2 or more (15.2% vs. 5%). Bone mineral density, urine pentosidine, homocysteine and bone specific alkaline phosphatase (BAP) significantly correlated with vertebral fractures among the patients and urinary pentosidine levels in the RA patients with fractures were significantly higher than without fractures. Patients using bisphosphonates was 33.3% in patients with rheumatoid arthritis. Bone mineral density was lower and more vertebral fractures was found in patients using bisphosphonates than in patients without bisphosphonates.

Vertebral fractures	Volunteers (n = 205)	RA (n = 208)
N = 0	70%	54.5%
N = 1	14.5%	10.1%
N = 2	8%	9.6%
N ≧ 3	7.5%	25.8%
SQ grade ≧ 2	5%	15.2%
Thoracic spine BMD	0.750±0.126	0.701±0.125
Lumbar spine BMD	0.930±0.163	0.896±0.164

Conclusion:

The incidence of vertebral fractures was higher in patients with RA than in volunteers. Bone quality markers and vertebral fractures are closely linked with RA. We will continue to prospectively investigate the incidence of new vertebral fractures and the progression of osteoporosis in patients with RA.

Disclosure:

T. Okano,
None;

T. Koike,

Chugai Pharmaceutical,

Eli Lilly Japan,

Novartis Pharmaceutical Corporation,

Teijin Pharma,

Bristol-Myers Squibb,

Ono Pharmaceutical,

Santen Pharmaceutical,

Eisai,

Abbott Japan,

Mitsubishi Tanabe Pharma Corporation,

Takeda Pharmaceutical,

Astellas Pharma Inc.,

Pfizer Japan Inc.,

Janssen Pharmaceutical,

Asahi Kasei Pharma Corporation,

Daiichi Sankyo Company,

M. Tada,
None;

K. Mamoto,
None;

Y. Sugioka,
None;

A. Kamiyama,
None;

H. Nakamura,
None.

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