THU0478 Before and after menopause, osteoporosis risk factors are different in women with rheumatoid arthritis
Authors: J.-F. Chen, T.-T. Cheng, S.-F. Yu, Y.-C. Chen, C.-Y. Hsu, H.-M. Lai, F.-M. Su, B. Y.-J. Su, W.-C. Chiu
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Rheumatoid arthritis (RA) is an autoimmune disease characterised by systemic inflammation, involving not only the juxta-articular bone erosion, but generalised bone loss[.<sup>1</sup> Sex hormone activates RA disease activity and induced bone resorption, but hormone replacement therapy increases bone mass and density. The ambiguous role of sex hormone on bone remodelling is confusing in RA patients. Under the impact of sex hormone, risk factors for osteoporosis might be different at pre- and post-menopausal stage. <h3>Objectives</h3> To investigate the different clinical risk factors of osteoporosis in pre- and post-menopausal women with RA. <h3>Methods</h3> A cross-sectional study was performed during 2014 to 2017, enrolling female participants fulfilled 2010 RA criteria[.<sup>2</sup> We recorded demographic data, risk factors for osteoporosis and blood test. Osteoporosis is defined if one of hip, distal forearm, and lumbar spine bone mineral density less than −2.5 by T-score for post-menopausal women, or less than −2.0 by Z-sore for pre-menopausal women. Data was analysed by Student's<i> t</i> test and Chi-square test for continuous and categorical valuables, respectively. Multivariate logistic regression was applied to detect association of osteoporosis and selected variables. <h3>Results</h3> A total of 451 participants were enrolled in the study, including 89 pre- and 362 post-menopausal women. The prevalence of osteoporosis is 14.6% and 36.7% for pre- and post-menopausal women with RA, respectively. At pre-menopause, low body weight is the only significant risk factors for osteoporosis, while old age, low body height, low body weight, positive anti-cyclic citrullinated peptide antibody (anti-CCP), previous fracture history, elevated white blood cell and platelet count, and lower calcium level are potential risk factors for post-menopausal women developing osteoporosis (table 1). Multivariate stepwise logistic regression analysis (table 2) showed body weight remains the leading risk factors in pre-menopausal women (Odds ratio[OR]=0.84, 95% confidence interval [CI]=0.76~0.94, P-value=0.002), while body weight and previous fracture history are significant risk factors in post-menopausal women(body weight OR=0.91, 95% CI=0.88~0.94, P-value&lt;0.001. previous fracture OR=2.03, 95% CI 1.13~3.64, P-value 0.02). <h3>Conclusions</h3> Risk factors of osteoporosis are different in pre- and post-menopausal women with RA. For pre-menopausal women, Low body weight is a leading risk factor, while low body weight and previous fracture history are important for post-menopausal women. Without protection of sex hormone, there are Potential roles of anti-CCP and white blood cell participating in osteoporosis pathogenesis and need more survey for confirmation. <h3>References</h3> [1] Lems WF, Dijkmans BA: <b>Should we look for osteoporosis in patients with rheumatoid arthritis?</b>Ann Rheum Dis1998, 57(6):325–327. [2] Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO, 3rd, Birnbaum NS, Burmester GR, Bykerk VP, Cohen MD, et al. <b>2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative</b>. Ann Rheum Dis2010,69(9):1580–1588. <h3>Acknowledgements</h3> Special thanks to Dr. Tien-Tsai, Cheng for his effort to establish the RA-GIOP database. <h3>Disclosure of Interest</h3> None declared