AB0619 DOES REGIONAL VARIATIONS IN ADIPOSITY PREDICT ONE VS MANY FRACTURES IN PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: H. Amin, A. Khan, Z. Sultan, M. Bukhari
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Rheumatoid arthritis patients are commonly on steroids for inducing disease remission (1), which often causes adipose tissue deposition (2). There is increasing evidence of the pathological effect of adiposity on bone including biomechanical, inflammatory and hormonal mechanisms. There is very little research exploring how adiposity effects fracture risk in patients with rheumatoid arthritis. <h3>Objectives:</h3> The aim of this study is to investigate whether adiposity could be a viable predictor of one versus many fractures in patients with rheumatoid arthritis. <h3>Methods:</h3> Patients were referred to our scanner in the northwest of England between 2004-2019 for dual-energy x-ray absorptiometry (DEXA) assessment from either primary or secondary care. Patients underwent demographic assessment via a questionnaire with correlation to the patients past medical history. Only patients with rheumatoid arthritis (RA) were included in our study. A logistic regression model reported odds ratios (OR) was fitted looking at fat percentage at the abdomen (FPA), fat percentage at the left and right hips (FPLH and FPRH) as predictor of both hip and non-hip fracture. We also used a partial body fat percentage (PBF) which used the total fat and lean masses at the above sites. All results were adjusted for age, gender, current steroid therapy, current smoking status, excess alcohol use (&gt;3 units per day) and the left femoral t-score. <h3>Results:</h3> 2,077 patients with RA were referred to our scanner including 1,632 female and 445 male patients. 462 patients reported single non-hip, 125 patients reported multiple non-hip and 97 patients reported a isolated hip fracture. The mean age was 66.9 years (SD 11.4), height 161.7 cm (SD 8.7), 71.9 KG (SD 16.7). 644 fractures were reported in RA patients including 97 hip and 587 non-hip. The mean PBF was 31.4% (SD 7.4), FPA 32.0% (SD 10.8), FPLH 31.3% (SD 7.1) and FPRH 30.8% (SD 7.0). Table 1 shows the result of our analysis. <h3>Conclusion:</h3> Only single non-hip fractures were predicted by adiposity, with FPA being the most accurate with a narrow confidence interval. Multiple non-hip and hip fractures were not predicted however we believe this is largely due to a small sample size of patients reporting hip and multiple non-hip fractures. Given that many RA patients are on steroids which predisposes to adiposity, this could be an important part of the pathogenesis of fragility fractures in this subset of patients. Further research is needed to explore this relationship in larger RA cohorts. <h3>REFERENCES:</h3> [1] Gøtzsche PC, Johansen HK. Meta-analysis of short-term low dose prednisolone versus placebo and non-steroidal anti-inflammatory drugs in rheumatoid arthritis. Bmj. 1998;316(7134):811-8. [2] Berthon BS, MacDonald-Wicks LK, Wood LG. A systematic review of the effect of oral glucocorticoids on energy intake, appetite, and body weight in humans. Nutr Res. 2014;34(3):179-90. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> Hamzah Amin: None declared, Aqib Khan: None declared, Zain Sultan: None declared, Marwan Bukhari Marwan Bukhari has been sponsored to attend regional, national and international meetings by UCB celltech, Roche/Chugai, Pfizer, Abbvie, Merck, Mennarini, Janssen, Bristol-Myers Squib, Novartis and Eli-lilly He has received honoraria for speaking and attended advisory boards with Bristol-Myers Squib, UCB celltech, Roche/Chugai, Pfizer, Abbvie, Merck, Mennarini, Sanofi-aventis, Eli-Lilly, Janssen, Amgen, Novartis and Gilead. He has received honoraria from educational groups revalidaid and TREG consultant.