Abstract
Aim. The 10-year probability of a FRAX for a major osteoporotic fracture (MOF) above 20% is considered a high fracture risk based on health and economic estimates. The aim of the current study was to identify the multivariate significant risk factors for FRAX MOF ≥20%, calculated by BMD of the femoral neck based on a assessment with the innovative radiofrequency echographic multispectrometry (REMS) ultrasound technique for axial skeletal scans.
Object of the study. For 304 women aged 40-90 years examined by REMS, age, height, weight, body mass index (BMI), menopause and the following risk factors for calculating FRAX were assessed - previous fractures, family history of hip fractures, smoking , alcohol consumption ≥3 units daily, use of corticosteroids (CS), diagnosed rheumatoid arthritis (RA) and secondary osteoporosis.
Methodology. According to the value of FRAX MOF women were divided into two groups - with FRAX MOF <20% and with FRAX MOF ≥20%. A binary logistic regression analysis was performed to assess the multivariate significant risk factors for FRAX MOF ≥20%.
Results and conclusions. Significant risk factors in the multivariate analysis for FRAX MOF ≥20% were previous fracture, use of CS, diagnosis of RA and BMDUS of the left femoral neck. The previous fracture increased the risk of FRAX MOF ≥20% by a factor of 38.77. Women who use CS showed about a 13.5-fold higher risk of FRAX MOF ≥20% than those who do not use CS. The diagnosis of rheumatoid arthritis increases the risk of FRAX MOF ≥20% by 6.92. Any 1% increase in left femoral BMD reduced the risk of FRAX MOF ≥20% by 0.29%. This specific model, designed to predict FRAX MOF ≥20% with REMS, may be useful for deciding on therapy in women with high risk factors for FRAX MOF ≥ 20%.
References
- Sözen T, Özışık L, Başaran NÇ. An overview and management of osteoporosis. Eur J Rheumatol. 2017;4(1):46-56.
- National Institute for Health and Care Excellence. NICE clinical guideline 146. Osteoporosis: assessing the risk of fragility fracture. London, UK: 2012. https://www.nice.org.uk/guidance/ cg146.
- Gullberg, B., O. Johnell, and J.A. Kanis, World-wide projections for hip fracture. Osteoporos Int. 1997; 7(5): 407-13.
- Odén A, McCloskey EV, Kanis JA, Harvey NC, Johansson H. Burden of high fracture probability worldwide: secular increases 2010-2040. Osteoporos Int. 2015;26(9):2243-8.
- Melton LJ 3rd, Atkinson EJ, O'Connor MK, O'Fallon WM, Riggs BL. Bone density and fracture risk in men. J Bone Miner Res. 1998;13(12):1915-23.
- Melton LJ 3rd, Chrischilles EA, Cooper C, Lane AW, Riggs BL. Perspective. How many women have osteoporosis? J Bone Miner Res. 1992;7(9):1005-10.
- Curtis EM, van der Velde R, Moon RJ, van den Bergh JP, Geusens P, de Vries F, van Staa TP, Cooper C, Harvey NC. Epidemiology of fractures in the United Kingdom 1988-2012: Variation with age, sex, geography, ethnicity and socioeconomic status. Bone. 2016;87:19-26.
- Hernlund E, Svedbom A, Ivergård M, Compston J, Cooper C, Stenmark J et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos. 2013;8(1):136.
- Kirilova E, Kirilov N. Osteoporotic fracture risk prediction tools. Revmatologiia/Rheumatology. 2019; 27(3): 55-65.
- Kirilova E, Kirilov N, Bischoff F. Predictive ability of the osteoporosis self-assessment tool for assessing the risk of osteoporosis. Revmatologiia/Rheumatology. 2019; 27(3): 3-9.
- Kanis JA, Dawson A, Oden A, Johnell O, de Laet C, Jonsson B. Cost-effectiveness of preventing hip fracture in the general female population. Osteoporos Int. 2001a; 12:356–61.
- Lam A, Leslie WD, Lix LM, Yogendran M, Morin SN, Majumdar SR. Major osteoporotic to hip fracture ratios in Canadian men and women with Swedish comparisons: a population-based analysis. J Bone Miner Res. 2014; 29:1067–73.
- Ettinger B, Black D, Dawson-Hughes B, Pressman AR, Melton LJ III. Updated fracture incidence rates for the US version of FRAX®. Osteoporos Int. 2009; 21:25–33.
- Kanis JA on behalf of the World Health Organization Scientific Group. Assessment of osteoporosis at the primary healthcare level. Technical Report. WHO Collaborating Centre, University of Sheffield, UK. 2008. Available at. http://www.shef.ac.uk/FRAX/pdfs/WHO_Technical_Report.pdf.
- National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis. National Osteoporosis Foundation; Washington, D C: 2008. 1–36.
- Tosteson, A. N., Melton, L. J., 3rd, Dawson-Hughes, B., Baim, S., Favus, M. J., Khosla, S. et al. Cost-effective osteoporosis treatment thresholds: The United States perspective. Osteoporos Int. 2008; 19:437–47.
- Morgan SL, Prater GL. Quality in dual-energy X-ray absorptiometry scans. Bone. 2017;104:13-28.
- Choksi, P., Jepsen, K.J. & Clines, G.A. The challenges of diagnosing osteoporosis and the limitations of currently available tools. Clin Diabetes Endocrinol 2018; 4, 12.
- Kirilova, E; Kirilov, N; Todorov, S; Nikolov, N; Nikolov, M; Krustev, E. Evaluation of scoliotic women with osteoporosis of the lumbar spine through DXA. Osteoporosis Int. 2020; 31(1): 482-482.
- Kirilova, E; Kirilov, N; Nikolov, N; Todorov, S; Nikolov, M; Krustev, E. DXA for assessment of bone mineral density of women with lumbar scoliosis. Osteoporosis Int. 2020; 31(1): 479-480.
- Hopkins SJ, Welsman JR, Knapp KM. Short-term precision error in dual energy X-ray absorptiometry, bone mineral density and trabecular bone score measurements; and effects of obesity on precision error. J Biomed Gr Comput 2014; 4:8–14.
- Tuna F, Yavuz S, Demirbağ Kabayel DD, Sarıkaya A. Effects of clinical reanalysis in dual energy X-ray absorptiometry reports. Turk J Phys Med Rehabil. 2017;63(3):201–206.
- Binkovitz LA, Henwood MJ. Pediatric DXA: technique and interpretation. Pediatr Radiol. 2007;37(1):21–31.
- Mazess RB. Bone density in diagnosis of osteoporosis: Thresholds and breakpoints. Calcif Tissue Int. 1987; 41:117–118.
- DiPaola M, Gatti D, Viapiana O, Cianferotti L, Cavalli L, Caffarelli C et al. Radiofrequency echographic multispectrometry compared with dual X-ray absorptiometry for osteoporosis diagnosis on lumbar spine and femoral neck. Osteoporos Int. 2019;30(2):391-402.
- Kanis JA, Johnell O, DeLaet C, Johansson H, Oden A, Delmas P et al. A meta-analysis of previous fracture and subsequent fracture risk. Bone. 2004; 35:375–382.
- Banefelt J, Åkesson KE, Spångéus A, Ljunggren O, Karlsson L, Ström O et al. Risk of imminent fracture following a previous fracture in a Swedish database study. Osteoporos Int. 2019;30(3):601-609.
- Van Staa TP, Laan RF, Barton IP, Cohen S, Reid DM, Cooper C. Bone density threshold and other predictors of vertebral fracture in patients receiving oral glucocorticoid therapy. Arthritis Rheum 2003; 48(11): 3224-3229.
- Saag KG, Zanchetta JR, Devogelaer JP, Adler RA, Eastell R, See K et al. Effects of teriparatide versus alendronate for treating glucocorticoidinduced osteoporosis: thirty-six-month results of a randomized, double-blind, controlled trial. Arthritis Rheum 2009; 60(11): 3346-3355.
- Saag KG. Prevention of glucocorticoid-induced osteoporosis. South Med J 2004; 97(6):555-558.
- Eastell R, Reid DM, Compston J, Cooper C, Fogelman I, Francis RM et al. A UK Consensus Group on management of glucocorticoid-induced osteoporosis: an update. J Intern Med. 1998;244(4):271-92.
- Grossman JM, Gordon R, Ranganath VK, Deal C, Caplan L, Chen W et al. American College of Rheumatology 2010 recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Care Res (Hoboken). 2010;62(11):1515-26.
- Manolagas SC, Weinstein RS. New developments in the pathogenesis and treatment of steroid-induced osteoporosis. J Bone Miner Res 1999; 14:1061.
- Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis: 2001 update. American College of Rheumatology Ad Hoc Committee on GlucocorticoidInduced Osteoporosis. Arthritis Rheum 2001;44(7):1496-1503.
- Kanis JA, Johansson H, Oden A, McCloskey EV. Guidance for the adjustment of FRAX according to the dose of glucocorticoids. Osteoporos Int. 2011; 22:809–816.
- Kim D, Cho SK, Choi CB, Jun JB, Kim TH, Lee HS et al. Incidence and risk factors of fractures in patients with rheumatoid arthritis: an Asian prospective cohort study. Rheumatol Int 2016;36:1205–14.
- Wang Y, Hao YJ, Deng XR, Li GT, Geng Y, Zhao J et al. Risk factors for bone mineral density changes in patients with rheumatoid arthritis and fracture risk assessment. Beijing Da Xue Xue Bao 2015;47:781–6.
- Wright NC, Lisse JR, Walitt BT, Eaton CB, Chen Z; Women's Health Initiative Investigators. Arthritis increases the risk for fractures--results from the Women's Health Initiative. J Rheumatol. 2011 Aug;38(8):1680-8.
- Lee SG, Park YE, Park SH, Kim TK, Choi HJ, Lee SJ et al. Increased frequency of osteoporosis and BMD below the expected range for age among South Korean women with rheumatoid arthritis. Int J Rheum Dis. 2012 Jun;15(3):289-96.
- Le Goff B, Blanchard F, Berthelot JM, Heymann D, Maugars Y. Role for interleukin-6 in structural joint damage and systemic bone loss in rheumatoid arthritis. Joint Bone Spine 2010;77:201–5.
- Polzer K, Joosten L, Gasser J, Distler JH, Ruiz G, Baum W et al. Interleukin-1 is essential for systemic inflammatory bone loss. Ann Rheum Dis 2010;69:284–90.
- Van den Berg WB. Uncoupling of inflammatory and destructive mechanisms in arthritis. Semin Arthritis Rheum 2001;30(5):7–16.
- Romas E, Gillespie MT, Martin TJ. Involvement of receptor activator of NF kappa B ligand and tumor necrosis factor-alpha in bone destruction in rheumatoid arthritis. Bone 2002;30:340–6.
- Sasaki N, Kusano E. Bone and bone related biochemical examinations. Bone and collagen related metabolites. Measurement and clinical role of OPG. Clin Calcium 2006;16:956–62.
- Kaz Kaz H, Johnson D, Kerry S, Chinappen U, Tweed K, Patel S. Fall-related risk factors and osteoporosis in women with rheumatoid arthritis. Rheumatology (Oxford) 2004;43:1267–71.
- Van den Bergh JP, van Geel TA, Geusens PP. Osteoporosis, frailty and fracture: implications for case finding and therapy. Nat Rev Rheumatol 2012;8:163–72.
- Xue AL, Wu SY, Jiang L, Feng AM, Guo HF, Zhao P. Bone fracture risk in patients with rheumatoid arthritis: A meta-analysis.Medicine (Baltimore). 2017;96(36):6983.
- Güler-Yüksel M, Allaart CF, Goekoop-Ruiterman YP, de Vries-Bouwstra JK, van Groenendael JH, Mallée C et al. Changes in hand and generalised bone mineral density in patients with recent-onset rheumatoid arthritis. Ann Rheum Dis. 2009;68(3):330-6.
- Haugeberg G, Conaghan PG, Quinn M, Emery P. Bone loss in patients with active early rheumatoid arthritis: infliximab and methotrexate compared with methotrexate treatment alone. Explorative analysis from a 12-month randomised, double-blind, placebo-controlled study. Ann Rheum Dis 2009;68:1898–901.
- Vis M, Guler-Yuksel M, Lems WF. Can bone loss in rheumatoid arthritis be prevented? Osteoporos Int 2013;24:2541–53.
- Mullen MB, Saag KG. Evaluating and mitigating fracture risk in established rheumatoid arthritis. Best Pract Res Clin Rheumatol 2015; 29:614–27.
- Siris ES, Adler R, Bilezikian J, Bolognese M, Dawson-Hughes B, Favus MJ et al. The clinical diagnosis of osteoporosis: a position statement from the National Bone Health Alliance Working Group. Osteoporos Int. 2014; 25:1439–43.
- Buckley LM, Leib ES, Cartularo KS, Vacek PM, Cooper SM. Effects of low dose methotrexate on the bone mineral density of patients with rheumatoid arthritis. J Rheumatol. 1997;24(8):1489-94.
- Genovese MC, Bathon JM, Martin RW, Fleischmann RM, Tesser JR, Schiff MH et al. Etanercept versus methotrexate in patients with early rheumatoid arthritis: two-year radiographic and clinical outcomes. Arthritis Rheum. 2002;46(6):1443-50.
- Wijbrandts CA, Klaasen R, Dijkgraaf MG, Gerlag DM, van Eck-Smit BL, Tak PP. Bone mineral density in rheumatoid arthritis patients 1 year after adalimumab therapy: arrest of bone loss. Ann Rheum Dis. 2009;68(3):373-6.
- Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2012;9:CD007146.
- Kirilov, N; Kirilova, E. Fracture risk assessment (FRAX) in women through radiofrequency echographic multispectrometry, Osteoporosis Int. 2019; 30(2): 436-S437.
- Kirilova E, Kirilov N, Popov I. Assessment of Fracture Risk through Radiofrequency Echographic Multi Spectrometry (REMS) based Bone Mineral Density. Ortho & Rheum Open Access J. 2019; 15(1): 555905.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.