Osteoporosis And Insufficiency Risk Factors In Psoriatic Arthritis

Background:Osteoporosis (OP) has been described to be frequent in spondyloarthritis [1]. However, the specific association of psoriatic arthritis (PsA) and bone fragility remains inconclusive, with a prevalence of OP ranging from 1.4–68.8 [2, 3].Objectives:The aim of this study was to describe the prevalence of osteopenia and OP in a representative cohort of patients with PsAMethods:Multi-centric, cross-sectional, descriptive study of patients with clinical diagnosis of PsA. Patients were randomly selected; they were invited to participate and were included after signing informed consent until the calculated sample size was reached. Clinical and demographic characteristics were recorded, as well as several protective and risk factors for osteoporosis and insufficiency fractures. Patients were asked to undergo a hip and lumbar (L2-L4) densitometry by DXA, and lateral X-Ray of the dorsal and lumbar spine if they had not these tests available in the previous year. The prevalence of osteoporosis and the risk factors was calculated. The characteristics of the patients with OP were compared to those without by univariate analyses, and were adjusted by age and sex. Multivariate analyse by ANOVA test was done to study the association of OP and fractures with clinical characteristics of the disease. The Clinical Research Ethics Committee of the Hospital General Universitario de Alicante (ISABIAL- approval number 180264) approved the studyResults:166 patients were included (Female 69%, male 30,1%), median age 58 (IR 51-65). Basal characteristics are shown in Table 1. Osteopenia or OP was present in 100 patients (60.2%). OP was present in 44 patients (26.5%). Among these, 9 patients (20.5%), all women ≥50 years old, had a total amount of 14 insufficiency fractures (4 vertebrae, 2 hips, 4 distal radius, 4 others). OP was present in 21.7% of the women, and 4.8% of the men. The most frequent risk factors among patients with OP were D-vitamin deficit (54.5%), sedentary life style by WHO standards (43.2%) and low calcium intake (38.6%). The most frequent protector factors in the group without osteopenia/nor OP was the intake of statins for ≥12 months. The presence of vertebral fractures was associated with female sex, sedentary lifestyle and age.Conclusion:The prevalence of insufficiency fractures among PsA patients was very superior to that recently found in the general population in Spain (prevalence 1.83%) [4]. Fractures are associated, similar to the general population, to female sex, sedentary life and age. Inherent factors to psoriatic disease may be responsible for this increased prevalenceReferences:[1]Moltó A et al. Prevalence of comorbidities and evaluation of their screening in spondyloarthritis: results of the international cross-sectional ASAS-COMOSPA study. Ann Rheum Dis. 2016;756:1016[2]Gulati AM et al. Bone mineral density in patients with psoriatic arthritis: data from the Nord-Trøndelag Health Study 3. RMD Open. 2017;3: e000413.[3]Busquets N et al. Bone mineral density status and frequency of osteoporosis and clinical fractures in 155 patients with psoriatic arthritis followed in a university hospital. Reumatol Clin. 2014;10:89.[4]Seoane-Mato D et al. Prevalence of rheumatic diseases in adult population in Spain (EPISER 2016 study): Aims and methodology. Reumatol Clin. 2019;15:90.Table 1.Basal characteristics (n=166)Age (years)57,9 (SD 0,8)Median 58 (IR 51-65)SexMale50 (30.1%)Female116 (69.9%)Duration of disease (years)10.3 (SD 0.63)Median 9 (IR 4.75-13)Type of PsAAxial15 (9%)Peripheral125 (75.3%)Both26 (15.7%)HAQ (n=142)0.47 (SD 0.05)Median 0.25 (IR 0-1)BASFI (n=40)3.7 (SD0.5)Median 3.6 (IR 1-5.75)cDMARDNever25 (15.1%)Previous/actual141 (85%)bDMARDNever84 (50.6%)Previous/actual82 (49.4%)PsA: psoriatic arthritisHAQ: Health Assessment QuestionnaireBASFI: Bath Ankylosing Spondylitis Functional IndexcDMARDs: classical disease modifying anti-rheumatic drugsbDMARDs biological drugsAcknowledgements:Thanks to doctors C. Fernández-Carballido, M Mínguez and G Panadero for their help recruiting candidates.Disclosure of Interests:None declared.