Assessment of the risk of vertebral fractures and their incidence in postmenopausal patients with rheumatoid arthritis

Abstract

Objective The incidence of vertebral fractures and their association with the activity, duration of the disease, therapeutic modality, lifestyle, and functional impairments. Material and methods This is a cross-sectional analytical study that includes 150 patients with an established diagnosis of definitive RA according to the ACR (American College of Rheumatology) criteria from 1987, treated on an outpatient and inpatient basis at the University Clinic of Rheumatology in Skopje between 2019-2021. The subjects are females aged 50-80 years, postmenopausal women with a menopause duration of ≥ 2 years. We include patients who have not previously been treated with bisphosphonate therapy. All subjects with RA were treated with nonsteroidal anti-inflammatory drugs (NSAIDs) and/or disease-modifying antirheumatic drugs (DMARDs) and corticosteroids (CS). Results The prevalence of vertebral fractures (VF) in postmenopausal patients with RA is 54.6%. Among 58 patients, VF with grade 2 reduction is 31.3%, mild fracture is 18.0%, and severe fracture is 5.3%. In patients due to CS therapy, there is an increased occurrence of VF, smoking is one of the significant risk factors (p>0.05), along with the duration and activity of the disease, while increased BMI reduces the risk of developing these fractures. In patients with vertebral fractures, osteopenia is registered in 51.2%, normal findings in 28.0%, and osteoporosis in 19.3%. There is a statistically significant association between osteopenia and normal findings versus vertebral fractures (Pearson Chi-square: 4.0793, df=1, p=.043412), as well as between osteoporosis and normal findings versus vertebral fractures (Pearson Chi-square: 4.7127, df=1, p=.029940) Conclusions RA represents a risk factor for the development of osteoporosis and increases the risk of vertebral and non-vertebral fractures in postmenopausal patients with RA. This risk is proportional to the reduction in weight, duration, and activity of the disease.