title: Prevalence of vertebral fractures in a disease activity steered cohort of patients with early active rheumatoid arthritis.
abstract: OBJECTIVE
  To determine the prevalence of vertebral fractures (VFs) after 5 years of disease activity score (DAS)-steered treatment in patients with early rheumatoid arthritis (RA) and to investigate the association of VFs with disease activity, functional ability and bone mineral density (BMD) over time.
  
  
  METHODS
  Five-year radiographs of the spine of 275 patients in the BeSt study, a randomized trial comparing four treatment strategies, were used. Treatment was DAS-steered (DAS ≤ 2.4). A height reduction >20% in one vertebra was defined a vertebral fracture. With linear mixed models, DAS and Health Assessment Questionnaire (HAQ) scores over 5 years were compared for patients with and without VFs. With generalized estimating equations the association between BMD and VFs was determined.
  
  
  RESULTS
  VFs were observed in 41/275 patients (15%). No difference in prevalence was found when stratified for gender, prednisone use and menopausal status. Disease activity over time was higher in patients with VFs, mean difference 0.20 (95% CI: 0.05-0.36), and also HAQ scores were higher, independent of disease activity, with a mean difference of 0.12 (95% CI: 0.02-0.2). Age was associated with VFs (OR 1.06, 95% CI: 1.02-1.09), mean BMD in spine and hip over time were not (OR 95% CI, 0.99: 0.78-1.25 and 0.94: 0.65-1.36, respectively).
  
  
  CONCLUSIONS
  After 5 years of DAS-steered treatment, 15% of these RA patients had VFs. Higher age was associated with the presence of VFs, mean BMD in hip and spine were not. Patients with VFs have greater functional disability over time and a higher disease activity, suggesting that VFs may be prevented by optimal disease activity suppression.
authors: Department of Rheumatology, Leiden University Medical Center, PO BOX 96002300 RC Leiden, The Netherlands. l.dirven@lumc.nl
authors: Linda
authors: L
authors: Dirven
authors: M
authors: M
authors: van den Broek
authors: J H L M
authors: JH
authors: van Groenendael
authors: W M
authors: WM
authors: de Beus
authors: P J S M
authors: PJ
authors: Kerstens
authors: T W J
authors: TW
authors: Huizinga
authors: C F
authors: CF
authors: Allaart
authors: W F
authors: WF
authors: Lems
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D015519:Bone Density; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D016017:Odds Ratio; D015995:Prevalence; D011859:Radiography; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016103:Spinal Fractures / Q000175:diagnosis / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D013997:Time Factors