AB0255 RISK OF FRAGILITY FRACTURE IN A COHORT OF PATIENTS WITH RHEUMATOID ARTHRITIS.
Authors: J. Malave Calzada, I. Braña Abascal, S. M. Rojas Herrera, R. Veroz Gonzalez, M. Priego Fernandez-Martos, D. Fernandez Lozano, M. D. C. Carrasco Cubero, J. J. Aznar Sanchez, L. M. Chaves Chaparro, E. Chamizo Carmona
Journal: Annals of the Rheumatic Diseases (2020)

Background: Rheumatoid Arthritis (RA) is associated with low bone density and hight risk fracture compared to general population. Objectives: The aim of this study is to assess the effect of some variables on fragility fractures in patients with RA. Methods: We perform an observational study in a cohort of patients diagnosed of RA according to 1987 and 2010 ACR criteria, to determine the frequency of osteoporotic fractures and associated clinical and densitometric variables. All patients diagnosed of RA were invited to participate in the study between 2013 and 2019, and to perform BMD DXA (GELunarProdigy®). SPSS25 was used to compare variables between patients with fracture and without fracture. Results: 376 patients with RA were included (78,7% women), mean age 63,3 (±13,2) years old and a mean of evolution of the RA of 118,7(±96,7) months at the moment the BMD was performed. We found bone fracture in 47 (12,6%) patients. Fractures were associated to female gender (OR: 2,93 (1,08-7,93); p=0,02), lower height and weight (p&lt;0,05) and older age (p=0,007). Table 1 shows the characteristics and differences between patients with and without fragility fractures. Women presented high risk of osteoporosis in lumbar spine [OR=3,89(1,46-10,37); p=0,002] than men, but any differences between gender were found in BMD of femoral neck. Of the fractured patients, BMD T-score was normal in 2 (4,3%), &lt;-1 in 45 (95,7%) and &lt;-2,5 en 25 (54,3%). In the multivariate analysis, the values of T score &lt;-1 and &lt;-2.5 of the hip were associated with fragility fracture, but not the value of T-score in lumbar spine. The risk of fracture decreases 0.008 with each mg/cm2 that increases BMD. The use of corticosteroids was associated with the development of femoral osteopenia [OR 2.04 (1.3-3.2); p = 0.002] but not with an increased risk of fractures. No significant association was found between fractures and the presence of RF, ACPAs, smoking, or treatment with biological therapy. Table 1. Characteristics Patients with fractures (n=47) Patients without fractures (n=327) OR (IC 95%); p value Females 43 (14,7%) 250 (85,3%) 2,9 (1,1-7,8); p=0,02 Age 67,7 (±10,6) 62,7 (±11,6) P=0,005 Height 152,4 (±9,4) 157,3 (±8,8) P=0,001 Weight 66,2 (±16) 73,3 (±14,4) P=0,003 Smokers 8 (12,1%) 58 (87,9%) 0,9 (0,4-2,1) p=0,89 RF (+) 35 (12,2%) 252 (87,8%) 0,9 (0,4-1,7) p=0,66 ACPA+ 30 (12,3%) 213 (87,7%) 1,3 (0,6-2,8) p=0,44 Steroids 36 (14,4%) 214 (85,6%) 1,7 (0,8-3,5) p=0,13 Biologics treatment 16 (16,2%) 83 (83,8%) 1,5 (0,8-2,9) p=0,22 Bone mineral density (BMD) in lumbar spine&lt;-1 34 (16,8) 168 (83,2) 2,6 (1,3-5,2) p=0,006 BMD femoral neck CF&lt;-1 43 (17,8) 198 (82,2) 9,0 (2,7-29,6) p&lt;0,001 BMD lumbar spine&lt;-2.5 17 (26,6) 47 (73,4) 3,4 (1,7-6,7) p&lt;0,001 BMD femoral neck&lt;-2.5 20 (29,4) 48 (70,6) 4,4 (2,3-8,5) p&lt;0,001 Major osteoporotic risk (FRAX) 37 (23,6) 120 (76,4) 7,4 (3,2-17,2) p&lt;0,001 Hip fracture risk (FRAX) 34 (24,5) 105 (75,5) 5,9 (2,8-12,5) p&lt;0,001 Conclusion: Women with RA present higher risk of fracture than men. The most sensitive indicator for fracture risk seems to be MBD in femoral neck. Disclosure of Interests: None declared