Osteoporosis risk factors analysis in rheumatoid arthritis patients: data from real practice

Background. Osteoporosis (OP) and its consequences is a pivotal medical and social problem. Rheumatic diseases especially rheumatoid arthritis (RA) is considered a key factor in the development of secondary OP. At the same time, patients with RA also have traditional risk factors (RF) for OP, as well as the adverse effects of drugs on bone metabolism. Consideration of the full spectrum in each patient with RA plays an important role in the individualized assessment of the risk of OP and the rational management.

The aim. To analyze the most significant RF of OP in a cohort of patients with verified RA observed by primary care specialists.

Materials and methods. Medical cards of 100 patients with determined RA (ACR / EULAR criteria) who were observed at out-patient clinics were studied. Along with the analysis of the clinical manifestations of RA, the registration of OP RF, both traditional and disease-related, was carried out with an analysis of the prevalence of RF in the investigated cohort.

Results. The RA cohort under study was dominated by patients with erosive arthritis, disease duration of more than 5 years, RF and/or ACCP positivity, moderate activity, functional class 2–3. Based on the available instrumental data, systemic OP was diagnosed in 33% of patients, while DXA-densitometry was performed only in 5% of patients with osteoporotic fractures. Among the traditional RF, the most significant were female sex, age higher than 50 years, BMI less than 20 kg/m2 . The frequency of registration of these RF was significantly higher in the subgroup of patients with confirmed OP. Of the disease-associated RF, the most common were the following: duration of RA more than 5 years, activity of 2–3 degrees, high titer of RF and ACCP, X-ray stage II and higher, long term systemic GC use.

Conclusions. In real practice, the diagnosis of OP in primary care in patients with RA is based on the available instrumental methods, preferably on standard radiography of bones and joints, which leads to underestimation and/or late diagnosis of OP. Patients with RA have a wide range of traditional and specific OP RFs, the assessment of which is important for determining the risk of fractures and timely prevention of OP complications.

1. Dydykina I. S., Alekseeva L.I. Osteoporosis in rheumatoid arthritis: diagnosis, risk factor, fractures, treatment. Scientific and practical rheumatology, 2011. No. 5. P. 13–17.

2. Dydykina PS, Petrova EV, Dydykina IS and others. Dynamics of clinical and radiological parameters during therapy with denosumab in patients with rheumatoid arthritis receiving glucocorticoids: preliminary results. Scientific and practical rheumatology. 2015; 53 (4): 397–402.

3. Nasonov E.L., Skripnikova I.A., Nasonova V.A. The problem of osteoporosis in rheumatology. M., Steen, 1997. 429 p.

4. Nasonov E.L. Glucocorticoid osteoporosis: current guidelines. Consilium medicum, 2002, 4, 8.

5. Osteoporosis: A Guide for Physicians. Ed. O.M. Lesnyak. M. GEOTAR-Media, 2016. 464 p.

6. Nikitinskaya O.A., Toroptsova N.V., Demin N.V. et al. The risk of osteoporotic fractures in patients with rheumatoid arthritis: the result of the Osteoscreening Russia program. Scientific and Practical Rheumatology. 2018; 56 (3): 310–315.

7. Ostrovsky A.B. Otteva E.N. Tarnavskaya T.S. Osteoporosis in rheumatoid arthritis. Far Eastern Medical Journal, 2012, No. 4, pp. 142–145.

8. Podvorotova M.M., Dydykina PS, Petrova E.V., Raskina T.A., Sorotskaya V.N., Dydykina I.S., Smirnov A.V., Alekseeva L.I. Osteoporosis in rheumatoid arthritis: risk factors for the development of osteoporosis. Scientific and practical rheumatology. 2013. V. 51. No. 5. P. 121.

9. Rebrova O. Yu. Statistical analysis of medical data. Application of the Statistica 2020 application package.

10. Russian clinical guidelines. Rheumatology Ed. E.L. Nasonova. M.: GEOTAR-Media. 2017. 464 p.

11. Taskina E.A., Alekseeva L.I. Risk factors for the development of osteoporosis in patients with rheumatoid arthritis. Scientific and practical rheumatology. 2014. 52 (5): 562–571.

12. Brosch S, Redlich K, Pietschmann P. Pathogenesis of osteoporosis in rheumatoid arthritis. Acta Med Austriaca. 2003; 30 (1): 1–5.

13. Forsblad d’Elia H, Larsen A, Waltbrand E. et al. Radiographic joint destruction in postmenopausal rheumatoid arthritis is strongly associated with generalized osteoporosis Annals of the Rheumatic Diseases 2003; 62: 617–623.

14. Hauberg G, Ostavik RE, Uhlig JA et al Clinical decision rules in rheumatoid arthritis: do they identify patients at high risk for osteoporosis? Testing clinical criteria in a population based cohort of patients with rheumatoid arthritis recruited from the Oslo RA Register. Ann Rheum Dis 2002; 61: 1085–1089.