Characteristics of osteoporosis/fragility fracture in Taiwanese rheumatoid arthritis patients: a sub-study of Taiwan OsteoPorosis Survey (TOPS)

台灣類風溼關節炎患者骨質疏鬆及脆弱性骨折的特色：台灣骨質疏鬆篩檢計畫之次分析

何曉儒(Hsiao-Ru He) ； 蘇昱日(Yu-Jih Su) ； 賴漢明(Han-Ming Lai) ； 尤珊富(Shan-Fu Yu) ； 邱文燦(Wen-Chan Chiu) ； 許鐘元(Chung-Yuan Hsu) ； 陳嘉夆(Jia-Feng Chen) ； 陳英州(Ying-Chou Chen) ； 柯祈化(Chi-Hua Ko) ； 王鈺維(Yu-Wei Wang) ； 鄭添財(Tien-Tsai Cheng)

《Formosan Journal of Rheumatology》 34卷1期 (2020/09) Pp. 1-8

https://doi.org/10.6313/FJR.202009_34(1).0001

摘要

Purpose: The aim of this study was to explore the characteristics of rheumatoid arthritis (RA)-associated osteoporosis/fracture in a Taiwanese population using Fracture Risk Assessment Tool (FRAX®) and to implement the FRAX-based intervention threshold for therapeutic decision-making. Methods: A cross-sectional cohort study of a nationwide osteoporosis screening program was conducted in Taiwan from 2008 to 2011. All participants were requested to complete a questionnaire including FRAX elements before bone mineral density (BMD) measurement. Participants with self-reported RA were assigned to the study group. The control group comprised of randomly selected age and gender-matched non-RA participants. Individual intervention threshold (IIT) was set at individual specific FRAX probability of a major osteoporotic fracture equivalent to that of prior fractures. The characteristics and calculated IITs of all participants were analyzed. Results: Altogether, 18992 participants were enrolled. The study included 880 participants with self-reported RA and 8656 age and gender-matched participants as the control group. BMD of the femoral neck (FN) and total hip in the RA group were significantly lower than that in the control group. However, the BMD values at L1-4 showed no significant difference. The T-score at the FN in the RA group was significantly lower than that in the control group. The overall prevalence of osteoporosis between the groups revealed no significant difference (19.8% vs. 17.6%, p=0.1021). The RA group demonstrated a significantly higher rate of FRAX risk factors. The FRAX scores for major fracture (15.3±10.8 vs. 8.7 ±6.9, p＜0.001) and hip fracture (6.2±8.1 vs. 3.0±4.7, p＜0.001) were significantly higher in the RA group than in the control group. The proportion of participants in the RA group with a 10-year probability of major osteoporotic fracture above IIT was significantly higher than that in controls (48.3% vs. 9.0%, p＜0.001). Conclusions: Lower BMD at the FN and the total hip, higher FRAX risks, and higher 10-year probability of fracture were observed in RA patients. The proportion of participants with 10-year probability of major osteoporosis fracture above IIT was significantly higher in the RA group than in the control group, suggesting that osteoporosis in RA patients could be undermanaged.

關鍵字

rheumatoid arthritis ； bone mineral density ； osteoporosis ； FRAX ； intervention threshold

並列摘要

目的：利用FRAX®骨折風險評估工具探討台灣類風溼性關節炎（RA）相關之骨質疏鬆及骨折風險，希望藉此幫助臨床醫師決定RA病人開始骨質疏鬆治療的時機。方法：2008年至2011年期間台灣骨質疏鬆症學會於全國進行骨密度篩檢計畫，參與民眾須於檢測骨密度前完成FRAX問卷。自述罹患RA患者設為實驗組，年齡及性別匹配之無罹患RA參與者作為對照組，針對兩組間骨密度、骨質疏鬆比例、FRAX骨折風險及個人化介入閾值進行比較。結果：共18,992位民眾參加篩檢，其中有880位民眾於問卷中自述罹患RA，與8,656位對照組民眾相較，RA患者於全髖骨及股骨頸處骨密度較低，股骨頸T-score亦較低，惟骨質疏鬆盛行率兩組並無顯著差異（19.8% vs. 17.6%, p=0.1021）。RA患者整體之FRAX計算之10年骨折機率（主要骨鬆性骨折，15.3±10.8 vs. 8.7 ±6.9, p＜0.001；髖骨骨折風險，6.2±8.1 vs. 3.0±4.7, p＜0.001）均個別顯著高於對照組，另外RA組之10年骨折機率（主要骨鬆性骨折）高於個人化介入閾值的比例也明顯高於對照組（48.3% vs. 9.0%, p＜0.001）。結論：本研究顯示台灣RA相關之骨質疏鬆治療應有可改進之空間。

並列關鍵字

類風溼性關節炎 ； 骨密度 ； 骨質疏鬆 ； FRAX ； 介入閾值