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FRAX and RA — SCE Rheumatology MCQ

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ModerateMetabolic Bone DiseaseFRAX and RASCE Rheumatology

A 62-year-old postmenopausal woman with established rheumatoid arthritis undergoes fracture-risk assessment using UK FRAX with femoral-neck bone mineral density. She has never received systemic glucocorticoids. Which statement best describes how rheumatoid arthritis is handled in FRAX?

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Correct answer: B — It is entered as a separate yes-or-no clinical risk factor and incorporated into the calculated 10-year fracture probability.

Rheumatoid arthritis is entered in FRAX as a separate dichotomous clinical risk factor and contributes to the calculated 10-year probabilities of major osteoporotic and hip fracture, including when femoral-neck BMD is used. There is no universal RA multiplier or automatic doubling: the change in absolute probability depends on the patient's other risk factors and the country-specific model. Glucocorticoid exposure is a separate FRAX input, so RA remains relevant without steroid use, excluding A. Entering BMD does not remove or reverse the RA contribution, excluding B and D. FRAX does not directly encode RA duration, disease activity or individual treatment effects, but contemporary studies do not justify a blanket assertion that it systematically underestimates risk in all patients with RA.

Reference: Klop C et al. Predicting the 10-year risk of hip and major osteoporotic fracture in rheumatoid arthritis and in the general population: an independent validation and update of UK FRAX without bone mineral density. Ann Rheum Dis. 2016. https://pubmed.ncbi.nlm.nih.gov/26984006/