md-medicaldata

Authors

 

Ivana Minaković^1,2 , Jelena Zvekić-Svorcan^1,3 , Tanja Janković^1,3, Rastislava Krasnik^1,4, Darko Mikić<sup>5,6

1</sup>University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
²Health Center Novi Sad, Novi Sad, Serbia
³Special Hospital for Rheumatic Diseases, Novi Sad, Serbia
⁴Institute of Child and Youth Health Care of Vojvodina, Novi Sad
⁵University of Defence, Medical Faculty of the Military Medical Academy
⁶Pathology and Forensic Medicine Institute, Belgrade, Serbia

 

UDK: 616.71-007.234-085
615.356.065

The paper was received / Rad primljen: 23.10.2020.

Accepted / Rad prihvaćen: 03.11.2020.

 

Correspondence to:

Ivana Minaković,
University of Novi Sad, Faculty of Medicine,
Hajduk Veljkova 3, 21000 Novi Sad, Serbia,
Phone number: +381669246406,
e-mail: ivana.minakovic@uns.ac.rs

 

 

Abstract

 

Introduction: Glucocorticoids play an important role in the treatment of rheumatoid arthritis, but the use of glucocorticoids also increases the risk of osteoporosis and pathological fractures. The aim of this study was to assess and compare the risk of hip fractures in patients with rheumatoid arthritis who use and patients who do not use glucocorticoid therapy, using the FRAX algorithm for the Serbian population. Material and methods: This retrospective cross-sectional study included 75 postmenopausal women with rheumatoid arthritis treated at the Special Hospital for Rheumatic Diseases, Novi Sad. Data were collected from patients' medical records, while bone mineral density was measured by osteodensitometry. A FRAX score was calculated separately for each subject to assess the ten-year risk of hip fracture, using an algorithm with and without bone mineral density. Results: Of the 75 subjects included in the study, 53 used and 22 did not use glucocorticoid therapy. Subjects who used glucocorticoid therapy had statistically significantly lower bone mineral density of the femoral neck (0.77 vs 0.86), p = 0.003. In the group of women who used glucocorticoids 50.94% of women had a high risk of developing a hip fracture, while this percentage in the group of women who did not use glucocorticoids was 9.09%. The statistically significant difference in the distribution of high and low risk for hip fracture existed when the FRAX algorithm was used with bone mineral density, as well when the FRAX algorithm was used without bone mineral density. (p = 0.001) Conclusion: Subjects with rheumatoid arthritis who was using glucocorticoid therapy had a statistically significantly lower bone mineral density of the femoral neck compared to patients with rheumatoid arthritis who did not use glucocorticoids. In the group of subjects who were using glucocorticoids, there were statistically significantly more women at high risk for developing a hip fracture, whether FRAX scores were calculated with or without the inclusion of bone mineral density.

 

 

 

Keywords:

Fracture risk; Hip fracture; FRAX; Bone mineral density; Glucocorticoid; Rheumatoid arthritis;

 

 

 

Sažetak

Uvod: Glukokortikoidi imaju važnu ulogu u lečenju reumatoidnog artritisa, ali upotreba glukokortikoida povećava rizik za nastanak osteoporoze i patoloških fraktura. Cilj ove studije bio je da se proceni i uporedi rizik za nastanak preloma kuka kod pacijenata sa reumatoidnim artritisom koji koriste i pacijenata koji ne koriste glukokortikoidnu terapiju, uz pomoć FRAX algoritma za srpsku populaciju. Materijal i metode: U ovu retrospektivnu studiju preseka uključeno je 75 postmenopauzalnih žena obolelih od reumatoidnog artritisa lečenih u Specijalnoj bolnici za reumatske bolesti, Novi Sad. Podaci su prikupljeni iz medicinskog kartona pacijentkinja, dok je mineralna koštana gustina merena osteodenzitometrijom. Za svaku ispitanicu je posebno izračunat FRAX skor za procenu desetogodišnjeg rizika za prelom kuka, koristeći algoritam sa i bez mineralne koštane gustine. Rezultati: Od 75 ispitanice koje su bile uključene u studiju, 53 su koristile, a 22 nisu koristile glukokortikoidnu terapiju. Ispitanice koje su koristile glukokortikoidnu terapiju imale su statistički značajno nižu mineralnu koštanu gustinu vrata butne kosti (0,77 vs 0,86), p=0,003. Visok rizik za nastanak frakture kuka u grupi žena koje su koristile glukokortikoide imalo je 50,94% žena, dok je ovaj procenat u grupi žena koje nisu koristile glukokortikoide iznosio 9,09%. Statistički značajna razlika u distribuciji visokog i niskog rizika za nastanak frakture kuka postojala je i pri korišćenju FRAX algoritma sa i FRAX algoritma bez mineralne koštane gustine. (p=0,001) Zaključak: Ispitanice sa reumatoidnim artritisom koje koriste glukokortikoidnu terapiju imaju statististički značajno nižu mineralnu koštanu gustinu na vratu butne kosti u odnosu na pacijentkinje sa reumatoidnim artritisom koje ne koriste glukokortikoide. U grupi ispitanica koje koriste glukokortikoide bilo je statistički značajno više žena sa visokim rizikom za nastanak frakture kuka, bilo da su FRAX skorovi računati sa ili bez uključivanja mineralne koštane gustine.

Ključne reči:

Rizik za frakturu; Fraktura kuka; FRAX; Mineralna koštana gusina; Glukokortikoidi; Reumatoidni artritis;

 

 

 

 

References:

1. Elde KD, Madsen OR. FRAX 10-yr Fracture Risk in Rheumatoid Arthritis—Assessments With and Without Bone Mineral Density May Lead to Very Different Results in the Individual Patient. J Clin Densitom. 2019;22(1):31-38.
2. Wilson JC, Sarsour K, Gale S, Pethö-Schramm A, Jick SS, Meier CR. Incidence and risk of glucocorticoid-associated adverse effects in patients with rheumatoid arthritis. Arthritis Care Res. 2019;71(4):498-511.
3. Tanaka Y. Rheumatoid arthritis. Inflammation and Regeneration. 2020;40(1):20.
4. Adami G, Saag KG. Glucocorticoid-induced osteoporosis update. Curr Opin Rheumatol. 2019;31(4):388-393.
5. Wang Y, Zhao R, Gu Z, Dong C, Guo G, Li L.  Effects of glucocorticoids on osteoporosis in rheumatoid arthritis: a systematic review and meta-analysis. Osteoporos Int. 2020;31(8):1401-1409.
6. Cavalli L, Guazzini A, Cianferotti L, Parri S, Cavalli T, Metozzi A, et al. Prevalence of osteoporosis in the Italian population and main risk factors: results of Bone Tour Campaign. BMC Musculoskelet Disord. 2016;17(1).
7. Kanis JA, Johansson H, Harvey NC, McCloskey EV. A brief history of FRAX. Arch Osteoporos. 2018;13(1).
8. Kanis JA, Johnell O, De Laet C, Jonsson B, Oden A, Ogelsby AK. International Variations in Hip Fracture Probabilities: Implications for Risk Assessment. J Bone Miner Res. 2002;17(7):1237-1244.
9. Kanis JA, Cooper C, Rizzoli R, Reginster JY. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2019;30(1):3-44.
10. https://www.sheffield.ac.uk/FRAX/tool.aspx?lang=srb (23.10.2020.)
11. Kanis JA, McCloskey E, Johansson H, Oden A, Leslie WD. FRAX® with and without Bone Mineral Density. Calcif. Tissue Int. 2012;90(1):1-13.
12. André V, le Goff B, Leux C, Pot-Vaucel M, Maugars Y, Berthelot JM. Information on glucocorticoid therapy in the main studies of biological agents. Joint Bone Spine. 2011;78(5):478-483.
13. Ma C, Xu S, Gong X, Wu Y, Qi S, Liu W, et al. Prevalence and risk factors associated with glucocorticoid-induced osteoporosis in Chinese patients with rheumatoid arthritis. Arch Osteoporos. 2017;12(1):33.
14. Igic N, Zvekić-Svorcan J. The impact of risk factors on the reduction of bone mineral density in postmenopausal women. MD-Medical Data. 2015;7(2):119-126.
15. Lai EL, Huang WN, Chen HH, Hsu CY, Chen DY, Hsieh TY, et al. Ten-year fracture risk by FRAX and osteoporotic fractures in patients with systemic autoimmune diseases. Lupus. 2019;28(8):945-953.
16. Ghazi M, Kolta S, Briot K, Fechtenbaum J, Paternotte S, Roux C. Prevalence of vertebral fractures in patients with rheumatoid arthritis: revisiting the role of glucocorticoids. Osteoporos Int. 2012;23(2):581-587.
17. Iacopo C, Alberto F, Daniela M, Cristina EV, Luigi G. Updates in epidemiology, pathophysiology and management strategies of glucocorticoid-induced osteoporosis. Expet Rev Endocrinol Metabol. 2020;15(4):283-298.
18. Lademann F, Tsourdi E, Hofbauer LC, Rauner, M. Thyroid Hormone Actions and Bone Remodeling – The Role of the Wnt Signaling Pathway. Exp Clin Endocrinol Diabetes. 2020;128(6-7):450-454.
19. Harvey NC, Glüer CC, Binkley N, McCloskey EV, Brandi ML., Cooper C, et al. Trabecular bone score (TBS) as a new complementary approach for osteoporosis evaluation in clinical practice. Bone. 2015;78:216-224.
20. Egsmose EL, Birkvig M, Buhl T, Madsen OR. FRAX fracture risk in women with a recent fracture of the distal forearm: agreement between assessments with and without bone mineral density and impact of measurement side in the individual patient. J Clin Rheumatol. 2015;34(7):1265-1272.
    

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