Abdominal Aortic Calcification Associated With Prevalent Vertebral Fractures in Women With Rheumatoid Arthritis

MRI scan of human lumbar spine with doctor
Researchers evaluated the prevalence of abdominal aortic calcification and its association with prevalent vertebral fractures in women with rheumatoid arthritis.

Among women with rheumatoid arthritis (RA), abdominal aortic calcification (AAC) detected on vertebral fracture assessment (VFA) is independently associated with prevalent vertebral fractures (VFs), according to study results published in Bone.

Previous studies have reported an association between AAC and risk for fracture in various populations; VFA-detected AAC is a potential predictor of low bone density and increased risk for VFs. However, limited data exist on the relationship between VFA-detected AAC and risk for VFs in patients with RA.

The objective of the current study was to investigate the association between VFA-detected AAC with prevalent VFs in women with RA.

The cross-sectional study included 250 women with RA (mean age, 55±11.3 years) who received treatment between January 2018 and March 2020 at a university hospital in Morocco. The study included patients who had available dual-energy x-ray absorptiometry (DXA) and VFA scans.

Approximately one-third of patients (96 women; 31.8%) had densitometric osteoporosis and 7 (2.8%) had a history of peripheral fracture. A total of 83 (33.2%) patients had a previous VF, including 59 (24.4%) with ≥2 VFs. Women with vs without VFs were older (mean age, 63.4 vs 50.9 years, respectively) and had lower lumbar spine (0.87 vs. 1.00, respectively) and total hip bone mineral density (0.80 vs. 0.91, respectively; P <.001 for all).

These data suggest an association between VFA-detected AAC and VFs, as AAC was significantly more common among participants with VFs than those without VFs (64.9% vs 26.1%, respectively). Furthermore, mean calcification score was significantly higher in women with vs without VFs (3.4 vs 0.7, respectively; P <.001 for both).

In multivariate analyses, there was a significant association between prevalent VFs and age of patients (odds ratio [OR], 1.132; 95% CI, 1.075-1.193; P <.001), densitometric osteoporosis at any site (OR, 3.584; 95% CI, 1.608-7.992; P =.002), disease activity (OR, 1.399; 95% CI, 1.015-2.929; P =.040), presence of rheumatoid factor antibodies (OR, 2.943; 95% CI, 1.132-7.654; P =.027), and VFA-detected AAC (OR, 2.598; 95% CI, 1.194-5.655; P =.016).

The study had several limitations, including the cross sectional design and the lack of standard spine radiographs.

“[T]he detection of AAC by DXA scans may provide an opportunity to identify [patients with] RA for the prevention of future VFs,” the researchers concluded.


Majjad A, Ghassem MA, Toufik H, et al. Relationship between vertebral fracture prevalence and abdominal aortic calcification in women with rheumatoid arthritis. Published online August 18, 2020. Bone. doi:10.1016/j.bone.2020.115599