Fracture Risk Assessment of Patients with Inflammatory Joint Disease Receiving Biological Agents Attending A Rheumatology Service in a University Affiliated Teaching Hospital


Órla McDonnell1, Mortimer B. O’Connor2, Ursula Bond2, Mark J. Phelan2


1The School of Medicine, University College Cork, Cork, Ireland 2Department of Rheumatology, South Infirmary Victoria University Hospital, Cork, Ireland


Osteoporosis, characterised by deteriorating bone microarchitecture with a concomitant increase in bone fragility, represents a growing public health concern. From an inflammatory arthropathy perspective, especially RA, it is a well-known extra-articular characteristic of concern. Fracture risk can be examined using the World Health Organization Fracture Risk Assessment Tool (FRAX®) which has been formulated to estimate a 10-year absolute risk of fracture using validated clinical risk factors.


The aims of our study were to determine the fracture risk in patients receiving biologic therapies using the FRAX® tool and to determine if a care-gap exists in this cohort.


A cross-sectional telephone based questionnaire study, employing the FRAX® tool, was conducted on Inflammatory arthropathy patients (RA, PsA, SNA, AS), receiving biological therapies, attending our Rheumatology service. Patients received a letter informing them of the study and pending telephone call one week in advance. Those not contactable within two attempted telephone calls were excluded from the study. Patients were randomly selected from the Departments Biologics database. Following FRAX® assessment, patients were classified as low, intermediate or high fracture risk using The National Osteoporosis Guideline Group (NOGG) analysis.


182 patients were telephoned with 123 patients being contactable within two attempts. 101 patients partook in the study. 8 (8%) had a prior osteoporosis diagnosis. 93 (92%) were eligible for FRAX® assessment with a mean age was 55.5 years (range: 40-75) and 53% male. Of the untreated group 77% had RA, 14% PsA and 8% AS. FRAX® assessment gave a median 10-year hip osteoporotic fracture probability of 2.1% (mean = 3.5%) and major osteoporotic fracture probability of 11% (mean = 12.4%). NOGG analysis would advise offering treatment to 25%, DXA imaging to 56% and osteoporosis/fracture risk lifestyle advice to 19% of patients. Thus a potential 81% of untreated patients may require osteoporosis/risk fracture prevention measures.


A large care-gap was identified among this patient group. Results highlight the need to identify and modify fracture risk in patients with inflammatory arthropathies receiving biologic therapies.