PO:20:005 | Sarcopenia and fracture risk in rheumatoid arthritis: correlation between SACR-F and fragility score measured by radiofrequency echographic multi-spectrometry

Sara Torracchi¹, Pamela Bernardini¹, Daniela Melchiorre¹, Bianca Bossi¹, Dorilda Zeka¹, Francesca Nacci¹, Lorenzo Tofani¹, Serena Guiducci¹ | ¹SOD Reumatologia, Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Italy

Background. To evaluate the effectiveness of the Fragility Score (FS), measured by Radiofrequency Echographic Multi-Spectrometry (REMS), in predicting fracture risk and its correlation with the risk of sarcopenia in patients with rheumatoid arthritis (RA).

Materials and methods. We examined a population of patients aged >50 years diagnosed with RA according to the 2010 ACR/EULAR criteria. All subjects underwent bone assessment using both REMS and DXA. The SARC-F questionnaire was administered and fracture risk was calculated using the DEFRA and FRAX algorithms. Correlations between FS, DEFRA, FRAX, and SARC-F were determined using Pearson’s correlation coefficient and its confidence interval (P<0.05).

Results. A total of 67 patients were enrolled, with a mean age of 66.94 ± 9.66 years; 60 were female (89.55%) and 7 male (10.45%). Mean DXA T-scores were: lumbar spine –1.73 ± 1.17 and femoral neck –1.99 ± 0.77; mean REMS T-scores were: lumbar spine –2.05 ± 0.90 and femoral neck –2.11 ± 0.79. Mean FRAX values were: hip fracture 11.33 ± 12.16 and major osteoporotic fractures 24.64 ± 16.07; DEFRA (in females) 42.98 ± 29.27; FS lumbar spine 43.89 ± 20.21; FS femur 41.57 ± 21.40; SARC-F 1.69 ± 1.59. A strong correlation was observed between the Fragility Score of both the lumbar spine and femur with the DEFRA and FRAX (for both major and hip fractures) fracture risk algorithms, with P-values <0.0001 for all correlations. A moderate correlation was found between SARC-F and bone structure quality assessed by the Fragility Score at the lumbar spine (r = 0.44, P<0.0001) and femur (r = 0.42650, P = 0.0002). Moreover, SARC-F showed a moderate correlation with fracture risk estimates obtained from DEFRA (r = 0.47390, P<0.0001), FRAX hip fracture (r = 0.39578, P = 0.0007), and FRAX major fractures (r = 0.37185, P = 0.0016).

Conclusions. REMS provides the qualitative parameter FS, which enables prediction of 5-year fracture risk. In our study, FS correlated significantly with both FRAX and DEFRA. Having a tool that allows for shorter-term prediction of fragility fractures, compared to algorithms based on DXA, appears to be of fundamental importance for optimal management of patients with RA. Our findings also reveal a correlation between sarcopenia risk, as assessed by the SARC-F screening questionnaire, and fracture risk estimated by FRAX®, DEFRA, and FS. Therefore, sarcopenia should be considered by clinicians in the management of RA patients, as it represents an additional factor contributing to increased fragility fracture risk.