Determination of the accuracy of osteoporotic fractures risk assessment in patients with rheumatoid arthritis using the prognostic model, developed at V.A. Nasonova Research Institute of Rheumatology, and the FRAX algorithm
https://doi.org/10.14412/1996-7012-2021-5-51-56
Abstract
Objective: comparison of the accuracy of risk assessment of low-energy fractures in patients with rheumatoid arthritis (RA) using the prognostic model developed at V.A. Nasonova Research Institute of Rheumatology, and the Russian model of the FRAX algorithm.
Patients and methods. A prospective long-term observational non-interventional study included 70 women aged 40–80 years with a definite diagnosis of RA (ACR, 1987). All patients underwent dual-energy X-ray absorptiometry at baseline and over time; clinical and anamnestic data were analyzed, including information on fractures that occurred during the observation period, confirmed by medical documents.
Results and discussion. The sensitivity and specificity of the FRAX algorithm were 67 and 56%, the sensitivity and specificity of the prognostic model of V.A. Nasonova Research Institute of Rheumatology – 78 and 56%, respectively. The diagnostic accuracy of the FRAX algorithm and the predictive model was 58 and 61%, respectively.
Conclusion. The predictive model developed at V.A. Nasonova Research Institute of Rheumatology, showed higher diagnostic accuracy and sensitivity, as well as comparable specificity with the FRAX algorithm in assessing fractures in RA patients.
About the Authors
P. O. KozhevnikovaRussian Federation
Polina Olegovna Kozhevnikova
34A, Kashirskoe Shosse, Moscow 115522
P. S. Kovalenko
Russian Federation
34A, Kashirskoe Shosse, Moscow 115522
I. S. Dydykina
Russian Federation
34A, Kashirskoe Shosse, Moscow 115522
S. I. Glukhova
Russian Federation
34A, Kashirskoe Shosse, Moscow 115522
A. M. Lila
Russian Federation
34A, Kashirskoe Shosse, Moscow 115522
2/1, Barrikadnaya Street, Build. 1, Moscow 125993
References
1. Nasonov EL, editor. Rossiiskie klinicheskie rekomendatsii. Revmatologiya [Russian clinical guidelines. Rheumatology]. Moscow: GEOTAR-Media; 2017. 464 p.
2. Guler-Yuksel M, Allaart CF, Goekoop-Ruiterman YP, et al. Changes in hand and generalised bone mineral density in patients with recent-onset rheumatoid arthritis. Ann Rheum Dis. 2009 Mar;68(3):330-6. doi: 10.1136/ard.2007.086348. Epub 2008 Mar 28
3. Schett G, Firestein GS. Mr Outside and Mr Inside: classic and alternative views on the pathogenesis of rheumatoid arthritis. Ann Rheum Dis. 2010 May;69(5):787-9. doi: 10.1136/ard.2009.121657. Epub 2010 Mar 18.
4. Lodder MC, de Jong Z, Kostense PJ, et al. Bone mineral density in patients with rheumatoid arthritis: relation between disease severity and low bone mineral density. Ann Rheum Dis. 2004 Dec;63(12):1576-80. doi: 10.1136/ard.2003.016253.
5. Van Staa TP, Geusens P, Bijlsma JW, et al. Clinical assessment of the long-term risk of fracture in patients with rheumatoid arthritis. Arthritis Rheum. 2006 Oct;54(10):3104-12. doi: 10.1002/art.22117.
6. Kim SY, Solomon DH. Risk of osteoporotic fracture in a large population-based cohort of patients with rheumatoid arthritis. Arthritis Res Ther. 2010;12(4):R154. doi: 10.1186/ar3107. Epub 2010 Aug 3.
7. Erwin J, Enki D, Woolf A. The risk of first and subsequent fractures in patients with rheumatoid arthritis in the UK. Ann Rheum Dis. 2019;78(Suppl 2):A184
8. Kim D, Cho SK, Choi CB, et al. Incidence and risk factors of fractures in patients with rheumatoid arthritis: an Asian prospective cohort study. Rheumatol Int. 2016 Sep;36(9):1205-14. doi: 10.1007/s00296-016-3453-z. Epub 2016 Mar 10.
9. Furuya T, Inoue E, Hosoi T, et al. Risk factors associated with the occurrence of hip fracture in Japanese patients with rheumatoid arthritis: a prospective observational cohort study. Osteoporos Int. 2013 Apr; 24(4):1257-65. doi: 10.1007/s00198-012-2080-0. Epub 2012 Jul 17.
10. Toroptsova NV, Feklistov AYu. The risk of falls in patients with rheumatoid arthritis. NauchnoPrakticheskaya Revmatologiya. 2016;54(6):705-11. (In Russ.).
11. Panafidina TA, Kondratyeva LV, Gerasimova EV, et al. Comorbidity in rheumatoid arthritis. Nauchno-Prakticheskaya Revmatologiya. 2014;52(3):283-9. (In Russ.).
12. Nikitina NM, Afanasyev IA, Rebrov AP. Comorbidity in patients with rheumatoid arthritis. Nauchno-Prakticheskaya Revmatologiya. 2015;53(2):149-54. (In Russ.).
13. Vis M, Haavardsholm EA, Boyesen P, et al High incidence of vertebral and non-vertebral fractures in the OSTRA cohort study: a 5-year follow-up study in postmenopausal women with rheumatoid arthritis. Osteoporos Int. 2011 Sep;22(9):2413-9. doi: 10.1007/s00198-010-1517-6. Epub 2011 Jan 13.
14. http://www.shef.ac.uk/FRAX
15. Amin S, Gabriel SE, Achenbach SJ, et al. Are Young Women and Men with Rheumatoid Arthritis at Risk for Fragility Fractures? A Population-Based Study. J Rheumatol. 2013 Oct;40(10):1669-76. doi: 10.3899/jrheum.121493. Epub 2013 Aug 15.
16. Lin YC, Li YH, Chang CH, et al. Rheumatoid arthritis patients with hip fracture: a nationwide study. Osteoporos Int. 2015 Feb;26(2):811-7. doi: 10.1007/s00198-014-2968-y. Epub 2014 Nov 20.
17. Siris ES, Genant HK, Laster AJ, et al. Enhanced prediction of fracture risk combining vertebral fracture status and BMD. Osteoporos Int. 2007 Jun;18(6):761-70. doi: 10.1007/s00198-006-0306-8
18. Kanis JA, Johansson H, Oden A, et al. Guidance for the adjustment of FRAX according to the dose of glucocorticoids. Osteoporos Int. 2011 Mar;22(3):809-16. doi: 10.1007/s00198-010-1524-7.
19. Raterman HG, Lems WF. Pharmacological Management of Osteoporosis in Rheumatoid Arthritis Patients: A Review of the Literature and Practical Guide. Drugs Aging. 2019 Dec;36(12):1061-72. doi: 10.1007/s40266-019-00714-4.
20. Klop C, de Vries F, Bijlsma JW, et al. Predicting the 10-year Risk of Hip and Major Osteoporotic Fracture in Rheumatoid Arthritis and in the General Population: An Independent Validation and Update of UK FRAX Without Bone Mineral Density. Ann Rheum Dis. 2016 Dec;75(12):2095-100. doi: 10.1136/annrheumdis-2015-208958
21. Podvorotova MM. Risk factors for skeletal bone fractures in rheumatoid arthritis. Autoref. diss. cand. med. sci. Moscow; 2013.
22. Jiang X, Gruner M, Tremollieres F, et al. Diagnostic accuracy of FRAX in predicting the 10-year risk of osteoporotic fractures using the USA treatment thresholds: A systematic review and meta-analysis. Bone. 2017 Jun;99:20-5. doi: 10.1016/j.bone.2017.02.008. Epub 2017 Mar 6.
23. Crandall CJ, Schousboe JT, Morin SN, et al. Performance of FRAX and FRAXБ – Based Treatment Thresholds in Women Aged 40 and Older: The Manitoba BMD Registry. Journal of Bone and Mineral Research. 2019 Aug; 34(8):1419-27. doi: 10.1002/jbmr.3717. Epub 2019 May 17.
24. Nikitinskaya OA, Toroptsova NV, Demin NV. Risk factors and bone mineral density in predicting the risk of fracture in postmenopausal women. Sovremennaya revmatologiya = Modern Rheumatology Journal. 2016;10(3): 23-8. (In Russ.). doi: 10.14412/1996-7012-2016-3-23-28
Review
For citations:
Kozhevnikova PO, Kovalenko PS, Dydykina IS, Glukhova SI, Lila AM. Determination of the accuracy of osteoporotic fractures risk assessment in patients with rheumatoid arthritis using the prognostic model, developed at V.A. Nasonova Research Institute of Rheumatology, and the FRAX algorithm. Sovremennaya Revmatologiya=Modern Rheumatology Journal. 2021;15(5):51-56. (In Russ.) https://doi.org/10.14412/1996-7012-2021-5-51-56