Assessment of fracture risk in patients with spondyloarthritis using the FRAX scores

Abstract

Osteoporosis and fractures are known to complicate spondyloarthritis (SA). The Fracture Risk Assessment Tool (FRAX) estimate the 10-year probability of major osteoporotic fracture (MOF) and also hip fracture (FH). It can be useful as risk assessment tools for the purpose of preventing fracture in SA. This study aimed to measure the bone mineral density (BMD), to evaluate the FRAX and to determinate factors associated with high risk of fracture in patients with SA. It’s a prospective cross-sectional study that included seventy-five patients admitted for SA, in the rheumatology department of Kassab institute in Tunisia. All of them fulfilled the modified New York criteria for SA.
Results: Sixty-two men and thirteen women were enrolled, with mean age of 36.8 ± 11.8 years. The mean age at disease onset was 27.8± 9.9 years.
Mean BASDAI and ASDAS CRP were respectively 3.5 ± 2.4 and 3 ± 0.83. The mean BASRI was 8.9 ± 4.2 and the mean mSASSS was 17.6 ± 19.6. Vitamin D insuffiency and deficiency were found in 43 and 30 patients respectively. Osteoporosis (T score ≤ -2,5 SD) were found in 49% of patients and 80 % of them have a reduced BMD (T score ≤ -1 SD). The mean MOF score was 0,36 ± 0,3 [0-0,9] and the mean FH score was 0,3 ± 0 [0-0,5].
The MOF was significantly associated with Bone loss (p=0.000). A trend for a significant association was also found with ASDASCRP (p=0.05). The MOF and FH were both significantly associated to the age at the onset of SA (respectively, p=0,003 and p=0,002). The risk of FH was higher when hip BASRI (p=0.036) and ESR were high (p=0,014), it’s also associated to age (p=0.002) and vitamin D deficiency (p= 0.043). However, no correlation was found between the MOF and FH and the presence of peripheral arthritis, enthesitis or hip arthritis.
Conclusion: The MOF score, in patient’s wih SA, was associated with bone loss, age at disease onset and ASDASCRP. The HF score was associated with age, Vitamine D deficiency, age at disease onset, high hip BASRI and high ESR.