Skip to main content

Prevalence of silent nontraumatic vertebral fracture in rheumatoid arthritis: relation with disease duration, disease activity, corticosteroid, and hip buckling ratio

Abstract

Objectives

To detect the prevalence of silent nontraumatic vertebral fractures (VFs) in patients with rheumatoid arthritis (RA) and its relation with disease duration, disease activity, corticosteroid (CS), and hip buckling ratio (BR).

Patients and methods

This cross-sectional study included a total of 150 RA patients. Disease activity was assessed using Disease Activity Score-28 (DAS-28). Dual-energy x-ray absorptiometry (DXA) was used to detect bone mineral density (B MD), VFs by vertebral fracture assessment (VFA), and hip BR by hip structural analysis program.

Results

A total of 17 (11.33%) RA patients had 27 silent VFs. Of the 17 VFs patients, 11 and six patients had single and multiple VFs, respectively. Of the 27 VFs, nine and 18 VFs had mild and moderate degree of VF. VF cases were significantly older in age (P = 0.001), had longer disease duration (P < 0.001), more active DAS-28 (P < 0.001), more cumulative CS dose, decreased spinal BMD (P = 0.02), and increased BR (P = 0.001). There were statistically significant relation between VFs and disease duration, DAS-28 and BR (P < 0.001 for all). VFs were independently associated with increased cumulative CS dose, high disease duration, and increased DAS-28 score (P < 0.001).

Conclusion

VFA-DXA should be performed on all RA patients. VF cases were significantly older in age, had long-standing disease duration, increased disease activity, reduced spinal BMD, increased cumulative CS dose, and increased BR. VFs were significantly related to increased disease duration, increased disease activity score, and increased BR of more than 10.

References

  1. Firestein GS. Immunologic mechanisms in thepathogenesis of rheumatoid arthritis. J Clin Rheumatol 2005; 11:S39–S44.

    Article  Google Scholar 

  2. Haugeberg G, Uhlig T, Falch JA, et al. Bone mineral density and frequency of osteoporosis in female patients with rheumatoid arthritis: results from 394 patients in the Oslo County Rheumatoid Arthritis register. Arthritis Rheum 2000; 43:522–530.

    Article  CAS  Google Scholar 

  3. Kvien TK, Haugeberg G, Uhlig T, et al. Data driven attempt to create a clinical algorithm for identification of women with rheumatoid arthritis at high risk of osteoporosis. Ann Rheum Dis 2000; 59:805–811.

    Article  CAS  Google Scholar 

  4. Dennison E, Cole Z, Cooper C. Diagnosis and epidemiology of osteoporosis. Curr Opin Rheumatol 2005; 17:456–461.

    Article  Google Scholar 

  5. Riggs BL, Melton LJIII. The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone 1995; 17:505S–511S.

    Article  CAS  Google Scholar 

  6. Lewiecki EM. Vertebral fracture assessment. Curr Opin Endocrinol Diabetes 2006; 13:509–515.

    Article  Google Scholar 

  7. Nampei A, Hashimoto J, Koyanagi J, et al. Characteristics of fracture and related factors in patients with rheumatoid arthritis. Mod Rheumatol 2008; 18:170–176.

    Article  Google Scholar 

  8. Arai K, Hanyu T, Sugitani H, et al. Risk factors for vertebral fracture in menopausal or postmenopausal Japanese women with rheumatoid arthritis: a cross-sectional and longitudinal study. J Bone Miner Metab 2006; 24:118–124.

    Article  Google Scholar 

  9. Orstavik RE, Haugeberg G, Uhlig T, et al. Vertebral deformities in 229 female patients with rheumatoid arthritis: associations with clinical variables and bone mineral density. Arthritis Rheum 2003; 49:355–360.

    Article  Google Scholar 

  10. De Nijs RN, Jacobs JW, Bijlsma JW , et al. Prevalence of vertebral deformities and symptomatic vertebral fractures in corticosteroid treated patients with rheumatoid arthritis. Rheumatology 2001; 40:1375–1383.

    Article  Google Scholar 

  11. El Maghraoui A, Rezqi A, Mounach A, et al. Prevalence and risk factors of vertebral fractures in women with rheumatoid arthritis using vertebral fracture assessment. Rheumatology 2010; 49:1303–1310.

    Article  Google Scholar 

  12. Arend WP, Dayer J-M. Cytokines and cytokine inhibitors or antagonists in rheumatoid arthritis. Arthritis Rheum 1990; 33:305–315.

    Article  CAS  Google Scholar 

  13. Adachi JD, Bensen WJ, Hodsman AB. Corticosteroid-induced osteoporosis. Semin Arthritis Rheum 1993; 22:375–384.

    Article  CAS  Google Scholar 

  14. Fuerst T, Wu C, Genant HK, et al. Evaluation of vertebral fracture assessment by dual X-ray absorptiometry in a multicenter setting. Osteoporos Int 2009; 20:1199–1205.

    Article  CAS  Google Scholar 

  15. Beck T. Measuring the structural strength of bones with dual-energy x-ray absorptiometry: principles, technical limitations, and future possibilities. Osteoporos Int 2003; 14:S81–S88.

    Article  Google Scholar 

  16. Leslie WD, Pahlavan PS, Tsang JF, et al. Manitoba Bone Density Program. Prediction of hip and other osteoporotic fractures from hip geometry in a large clinical cohort. Osteoporos Int 2009; 20:1767–1774.

    CAS  Google Scholar 

  17. Young WC. In: Young WC, Budynas RG, Roark RJ, editors. Elastic stability formulas for stress and strain. Roark’s formulas for stress and strain. ISBN 0-07-100373-8. 6th ed. New York, USA: McGraw-Hill; 1989.

    Google Scholar 

  18. Aletaha D, Neogi T, Silman A, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 2010; 62:2569–2581.

    Google Scholar 

  19. Prevoo MLL, van’t Hof MA, Kuper HH, et al. Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arth Rheum 1995; 38:44–48.

    CAS  Google Scholar 

  20. Genant HK, Wu CY, van Kuijk C, Nevitt MC. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 1993; 8:1137–1148.

    Article  CAS  Google Scholar 

  21. Van Brussel MS, Lems WF. Clinical relevance of diagnosing vertebral fractures by vertebral fracture assessment. Curr Osteoporos Rep 2009;7:103–106.

    Article  Google Scholar 

  22. Orstavik RE, Haugeberg G, Uhlig T, et al. Self reportednon-vertebral fractures inrheumatoid arthritis and populationbasedcontrols: incidence and relationship withbone mineral density and clinical variables. Ann Rheum Dis 2004; 63:177–182.

    Article  CAS  Google Scholar 

  23. Kaptoge S, Beck T, Reeve J, et al. Prediction of incident hip fracture risk by femure geometry variabales measured by hip structural analysis in the study of osteoporotic fractures. J Bone Miner Res 2008; 23: 1892–1904.

    Article  Google Scholar 

  24. Rivadeneira F, Zillikens MC, De Laet CE, et al. Femoral neck BMD is a strong predictor of hip fracture susceptipility in ealdrly men and women because it detects cortical bone instability: the Rotterdam Study. J Bone Miner Res 2007; 22:1781–1790.

    Article  Google Scholar 

  25. Wright N, Lisse J, Thomas J, et al. Rheumatoid arthritis is associated with less optimal hip structural geometry. J Clin Densitom 2012; 15:39–48.

    Article  Google Scholar 

  26. Elwakd M, Bassyouni I, Omar H, Kamel A, Abou Senna H, Eltahlawy E, Elbadawy S. Femoral narrow neck geometry and strength indices assessed by dual-energy X-ray absorptiometry in postmenopausal women with osteoporotic vertebral fracture. Osteoporos Int 2014; 25:S42–S43.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mohamed M. El-Wakd.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

El-Wakd, M.M., Omar, O.H. & Senna, H.A. Prevalence of silent nontraumatic vertebral fracture in rheumatoid arthritis: relation with disease duration, disease activity, corticosteroid, and hip buckling ratio. Egypt Rheumatol Rehabil 41, 116–121 (2014). https://doi.org/10.4103/1110-161X.140527

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/1110-161X.140527

Keywords

  • disease activity
  • osteoporosis
  • rheumatoid arthritis
  • vertebral fracture assessment