Open Access Highly Accessed Research article

Prevalence of vertebral fractures in a disease activity steered cohort of patients with early active rheumatoid arthritis

Linda Dirven1*, M van den Broek1, J H L M van Groenendael2, W M de Beus3, P J S M Kerstens4, T W J Huizinga1, C F Allaart1 and W F Lems45

Author Affiliations

1 Department of Rheumatology, Leiden University Medical Center, PO BOX 9600, 2300 RC, Leiden, The Netherlands

2 Franciscus Hospital, Roosendaal, the Netherlands

3 MCH Haaglanden, Leidschendam, the Netherlands

4 Jan van Breemen Research Institute | Reade, Amsterdam, the Netherlands

5 VUMC, Amsterdam, the Netherlands

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BMC Musculoskeletal Disorders 2012, 13:125  doi:10.1186/1471-2474-13-125

Published: 23 July 2012



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.


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.


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).


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.

Rheumatoid arthritis; Vertebral fractures; Bone mineral density; Functional ability; Disease activity; Treatment strategy