Background: Numerous studies conducted over the past decades have revealed that, in addition to joint inflammation and degeneration, RA patients have lower bone mass and are more likely to develop osteoporosis. In a similar way, there is a substantial risk of osteoporotic fractures, particularly when it is compared with normal population of the same sex and age.
Aim of the work: To assess risk of fracture in Egyptian patients with RA and effect of anti-rheumatic medications on fracture risk.
Patients and Methods: 100 patients diagnosed as RA, met the American College of Rheumatology / European League Against Rheumatism (ACR/EULAR) 2010 criteria for RA, aged 40 years or more, and 50 healthy control. Thorough history including fracture and treatment history, clinical assessment by HAQ-DI and DAS-28 ESR, and laboratory assessment, FRAX and DEXA were done.
Results: Osteoporosis was present in 34% of patients, 16% of controls. Only 4% of patients had major osteoporotic fracture risk, 14% had hip fracture risk. For control group, 2% had major osteoporotic fracture risk, 6% had hip fracture risk. A significant higher risk for both major osteoporotic and hip fractures in patients compared to control and an increased risk of osteoporosis. An inverse correlation between FRAX and disease duration, vitamin D, BMI, DEXA, leflunamide, HCQ, and biologic treatment. A direct correlation between FRAX and DAS28-ESR, HAQ-DI, CRP, ESR, age, females, smoking, high dose steroid, methotrexate, combined treatment, RF, and anti-CCP. An inverse correlation between DEXA and disease duration, DAS28-ESR, HAQ-DI, serum calcium, and ESR.