Prevalence of silent nontraumatic vertebral fracture in rheumatoid arthritis : relation with disease duration, Disease activity, corticosteroid, and hip buckling ratio

Objectives : To detect the prevalence of silent nontraumatic vertebral fractures (VFs) in patients with rheumatoid arthritis (RA) and its relation with disease duration, disease activity, corticosteroid (CS), and hip buckling ratio (BR). Patients and methods : This cross-sectional study included a total of 150 RA patients. Disease activity was assessed using Disease Activity Score-28 (DAS-28). Dual-energy x-ray absorptiometry (DXA) was used to detect bone mineral density (BMD), VFs by vertebral fracture assessment (VFA), and hip BR by hip structural analysis program. Results : A total of 17 (11.33 %) RA patients had 27 silent VFs. Of the 17 VFs patients, 11 and six patients had single and multiple VFs, respectively. Of the 27 VFs, nine and 18 VFs had mild and moderate degree of VF. VF cases were significantly older in age (P = 0.001), had longer disease duration (P < 0.001), more active DAS-28 (P < 0.001), more cumulative CS dose, decreased spinal BMD (P = 0.02), and increased BR (P = 0.001). There were statistically significant relation between VFs and disease duration, DAS-28 and BR (P < 0.001 for all). VFs were independently associated with increased cumulative CS dose, high disease duration, and increased DAS-28 score (P < 0.001). Conclusion : VFA-DXA should be performed on all RA patients. VF cases were significantly older in age, had long-standing disease duration, increased disease activity, reduced spinal BMD, increased cumulative CS dose, and increased BR. VFs were significantly related to increased disease duration, increased disease activity score, and increased BR of more than 10.