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Factors Influencing Fracture Risk, T Score, and Management of Osteoporosis in Patients With Rheumatoid Arthritis in the Consortium of Rheumatology Researchers of North America (CORRONA) Registry

Coulson, Kathryn A. MD*; Reed, George PhD; Gilliam, Brooke E. BA*; Kremer, Joel M. MD; Pepmueller, Peri H. MD*

JCR: Journal of Clinical Rheumatology: June 2009 - Volume 15 - Issue 4 - p 155-160
doi: 10.1097/RHU.0b013e3181a5679d
Original Article

Objectives: This study examined a wide array of clinical factors to evaluate their influence on fracture risk and T scores in women with rheumatoid arthritis (RA) and determine if women with RA who are at risk for osteoporosis (OP) are adequately treated with OP medications.

Methods: Data from 8419 female RA patients participating in the Consortium of Rheumatology Researchers of North America registry from March 02, 2006 to August 15, 2006 was evaluated. Covariates included medication subgroups, demographic, and clinical parameters. Lumbar spine and hip T scores and fracture rates were studied in relation to the variables. Use of OP medications in patients with OP risk factors was also evaluated.

Results: Postmenopausal status and higher modified health assessment questionnaire score (mHAQ) had a negative effect on lumbar spine score, while marriage, education, and body mass index had a positive effect. A similar trend was found with hip T scores. Increase in overall fracture risk correlated with postmenopausal status, mHAQ, and prednisone use, while tumor necrosis factor monotherapy was associated with decreased overall fracture risk. mHAQ was also associated with nonhip/nonspine fractures. Eighty percent of patients had at least 1 risk factor for OP, but only 32% were on OP medications. Only 54% of patients with 3 risk factors were on OP medication.

Conclusions: In RA, postmenopausal status, mHAQ, and prednisone use were associated with a higher overall fracture risk. Women with RA who were at risk for OP may have been inadequately treated with OP medications.

RA patients are at increased risk for osteoporosis but rheumatologists often do not investigate or treat these at risk people.

From the *Division of Rheumatology, Saint Louis University School of Medicine, Saint Louis, Missouri; †Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; and ‡Division of Rheumatology, The Albany Medical College, Albany, New York.

Supported from the Consortium of Rheumatology Researchers of North America, Inc.

Correspondence: Kathryn A. Coulson, MD, Room 213A Doisy Hall, 1402 South Grand Blvd., Saint Louis, MO 63104. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.