Background Only postmenopausal women were in the researcher9s focus in the majority of publications on osteoporosis (OP) risk factors (RF) in RA female patients (pts). Meanwhile the data on OP RF in menstruating women presented in the rare available papers are not consistent. Objectives To identify the major OP RF in RA female pts with normal menstrual cycle. Methods 51 RA (based on ACR criteria) female pts with normal menstrual cycle aged 20 to 51 years (mean age 41,1±7,9) were examined. The following info was included in each individual pts9 files: anthropometric parameters, social and demographic data, case history, clinical examination and lab findings, traditional OP RF, pts9 joint status, comorbidities status, pain intensity assessments and VAS evaluation of pts9 general health status. Axial bone mineral density (BMD) was measured with DEXA scan using Z-score calculator. Based on the OP status all pts were divided into 2 groups:pts with OP–16 (31,4%), and pts without OP–35 (68,6%). Results Comparative analyses of the groups showed that: OP pts were younger vs the pts without OP (36,9±10 vs 42,8±6,3 years, p=0,02). Disease duration was comparable in both groups. Clinical manifestations of inflammation activity (mean DAS 28 score and hsCRP) were statistically significantly more pronounced in the OP group vs the pts without OP (4,91±1,39 vs 4,19±1,06, p=0,049; 27,8 (10,8–43,5) vs 7,4 (1,4–22,7) mg/L, p=0,02, respectively). High DAS 28 (50 vs 20,6%, RR=2,43, 95% CI 1,07–5,53, p=0,03) scores were more often documented in the OP pts. Pronounced feet and hand bone destruction based on the radiographic findings was documented in the majority of pts in both groups, although in the OP pts the joint space narrowing counts (97 (62,5–121) vs 73,5 (53–87), p=0,02) and the total Sharp score (98 (64,5–183) vs 89,0 (63–112), p=0,03) were statistically significantly higher. The OP pts were more often administered oral GCs (81,3 vs 37,1%, RR=2,19, 95% CI 1,34–3,57, p=0,004), as well as GCs -pulse therapy (56,3 vs 25,7%, RR=2,18, 95% CI 1,08–4,45, p=0,04), had higher GCs cumulative dose (18,8 (8,1–30,7) vs 6,4 (0,8–14,1)g, p<0,01), higher GC daily dose at the time of examination (8,8 (6,3–10) vs 5 (3,8–6,3)mg/day, p=0,01) and higher average daily dose in the previous year (8,8 (5–10) vs 3,8 (2,5–6,3)mg/day, p=0,01) versus the pts without OP. Analysis of traditional RF (low body weight/BMI, long immobilization periods, smoking, family history of OP and others) showed no difference between the two groups. Discriminant analysis revealed the following major OP RF in the RA female pts before menopause: RA activity (based on the Das 28 score) and GCs dose at the time of examination (given GCs therapy lasts ≥3 months). Meanwhile the patient9s body weight and age at the onset of RA were identified as protective factors for BMD. Based on the abovementioned risk and protective factors and the derived coefficients the authors designed a formula allowing to predict of OP in female RA pts before menopause with high accuracy (area under the ROC-curve=0,833). The model accuracy is 85,1%. Conclusions RA activity and GCs dose (GCs therapy duration ≥3 months) were identified as the major OP RF in young RA female pts before menopause, thus adequate and timely therapy aimed at obtaining RA control and achieving remission should be considered as key OP prevention strategy. Disclosure of Interest None declared

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Aim. To obtain information on and to study an association between the erosive and destructive changes in the hand and foot joints, bone mineral density (BMD) in different parts of the skeleton and the X-ray alterations in the thoracic and lumbar vertebrae of patients with rheumatoid arthritis (RA).Subjects and methods. The investigation enrolled 66 women with a valid RA diagnosis, whose mean age was 51.6 +/- 9.6 years and the disease duration was 13.2 +/- 9.1 years. All the patients underwent clinical, laboratory, and X-ray studies assessing the progression of joint changes by the Sharp/van der Heijde method and estimating the vertebral body deformity index by the Genant technique, and BMD in 3 skeletal regions by dual-energy X-ray absorptiometry employing a Holovic Discovery A device.Results. With X-ray higher-stage RA and higher Sharp total scores, regardless of age, there was a decrease in BMD in all skeletal areas and an increase in the number of patients with deformities of vertebrae and osteoporosis (OP) in at least one of the analyzed skeletal part. Thus, OP was found in 29% of the patients with Stages I and II RA and in 65% of those with Stages IV; deformities of vertebrae were in 12 and 22%, respectively. Comparative analysis of BMD and erosive and destructive changes in the patient groups different in age at onset of the disease has established that its young onset (from 16 to 30 years) and long duration have a negative effect on bone status. Femoral neck BMD in these patients is significantly lower than that in patients who were ill at older age (31-50 or over 50 years) (0.661 +/- 0.080, 0.739 +/- 0.111, and 0.713 +/- 0.120 g/cm(2), respectively) and the Sharp total score was higher (181.1 +/- 91.3, 100.5 +/- 71.5 and 103.9 +/- 74.5, respectively). The patients' mean age in these groups at the study inclusion was 46.7 +/- 12.1, 51.9 +/- 6.7, and 60.3 +/- 3.3 years, respectively.Conclusion. With the longer disease duration, regardless of the age of patients with RA, there are increases in both Sharp total scores, X-ray RA stage, and the number of patients with OP, deformities of thoracic and lumbar vertebrae (however, there is no evidence of significant differences), BMD decrease in all skeletal parts.

Aim. To determine an absolute risk of fractures in patients with rheumatoid arthritis (RA) with the FRAX procedure (fracture risk assessment tool) for choice of further prophylactic, therapeutic and rehabilitative measures. Material and methods. The trial included 611 RA females over 49 years of age of 834 RA patients from 2004 data base RA entrees. All the patients were assessed for fracture risk with FRAX basing on clinical data without densitometry. Distribution into fracture risk groups was made by a graphic age-risk scheme. Results. High or moderate fracture risk was registered in 58.6 % RA examinees. These patients were older than those with a low fracture risk, they had lower body mass index, longer menopause, higher disease activity, more often had extra-articular manifestations of the disease. Therefore, duration of their glucocorticosteroid treatment was longer. Patients with high and moderate fracture risks more frequently had functional insufficiency of the third degree, fractures of skeletal bones in the past. Conclusion. The FRAX method for assessment of an absolute fracture risk in RA patients detects subjects with elevated risk of fractures. This facilitates timely and qualitative administration of medical care, lowers costs of examination, improves treatment and rehabilitation of patients with osteoporosis and its complications.