Disease activity score is associated with vertebral fragility fractures in patients with rheumatoid arthritis: a cross-sectional multidisciplinary study

: Rheumatoid Arthritis (RA) is associated with osteometabolic alterations. This study aims to estimate the prevalence of osteometabolic complications and to explore the potential association with disease parameters in patients with RA. This cross-sectional study enrolled consecutive patients with diagnosis of RA, admitted to Rheumatology Unit of our Hospital and referred to the Endocrinology Unit for the assessment of osteometabolic health. Anamnestic, anthropometric, biochemical and instrumental data were collected for each subject. The prevalence of osteometabolic alterations was 35% for sarcopenia, 41% for osteoporosis and 28% for vertebral fragility fractures in a population of 110 RA patients. At multivariable analysis, copeptin showed direct association (β-coeff 0.006; p = 0.015) with lower lumbar bone mineral density (BMD) values on dual-energy X-ray absorptiometry (DXA). Disease Activity Score for 28 joints with C-Reactive Protein (DAS28-CRP) (OR 1.632; p = 0.031) proved to be associated with vertebral fragility fractures, correcting for age, sex, body mass index (BMI) and disease parameters. Furthermore, DAS28-CRP (β-coeff 0.584; p = 0.001), steroid therapy (β-coeff 0.993; p = 0.013), and old age (β-coeff 0.040; p = 0.013) were directly associated with sarcopenia score (SARC-F), while male sex showed indirect association (β-coeff - 1.027; p = 0.036), correcting for autoantibody positivity and BMI. In the last model, copeptin resulted indirectly associated with fat mass index on DXA (β-coeff - 0.236, p = 0.049), using age and disease parameters, as covariates. RA is characterized by a high prevalence of osteometabolic complications, caused by a complex interplay between autoimmune and metabolic pathways. Management of osteometabolic health in RA patients should be a shared decision making between rheumatologist and endocrinologist.