High disease activity influences the presence of vertebral fractures in rheumatoid arthritis

High disease activity influences the presence of vertebral fractures in rheumatoid arthritis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research article High disease activity influences the presence of vertebral fractures in rheumatoid arthritis Hideo Sakane, Koichi Okamura, Yoichi Iizuka, Akira Honda, Eiji Takasawa, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-942051/v2 This work is licensed under a CC BY 4.0 License Status: Posted Version 2 posted You are reading this latest preprint version Show more versions Abstract Introduction: It is important to assess the risk of vertebral fractures (VFs) in patients with rheumatoid arthritis (RA), as RA is associated with a high risk of VFs. However, the epidemiology and risk of VFs in patients with RA remain inconclusive. The present study therefore clarified the prevalence and associated factors of VFs in patients with RA. Methods: We included 107 patients (19 men and 88 women) and retrospectively investigated the number and location of VFs, bone mineral density (BMD), RA disease activity score for 28 joints based on C-reactive protein (DAS28-CRP), and history of medication for RA and osteoporosis. Based on the investigated items, we assessed the prevalence of VFs in patients with RA and the association between the clinical parameters of RA patients and VFs. Results: The average age, disease duration, and DAS28-CRP were 67.9 years old, 14.9 years, and 2.2, respectively. We found that the prevalence of VFs in patients with RA was 30.8%, and 84.8% of patients with VFs and 62.2% of those without VFs had been treated for osteoporosis. We further found that the prevalence of VFs in patients with RA with a history of anti-osteoporotic agent use was 37.8%. In univariate analyses, patients with RA with VFs had significantly higher DAS28-CRP values, a higher rate of corticosteroid use, and lower BMD (p = 0.018, p = 0.004, and p < 0.001, respectively) than those without VFs. A logistic regression analysis and ordinal logistic analysis revealed that the DAS28-CRP and BMD were independent factors associated with the presence (p = 0.042 and p = 0.011, respectively) and number (p = 0.036 and p = 0.048, respectively) of VFs. Conclusions: The prevalence of VFs was relatively high in patients with RA, regardless of the use of anti-osteoporotic agents. A high disease activity score and low BMD are associated with the presence and number of VFs in patients with RA. Based on these findings, to reduce VFs in RA patients, it is important to tightly control the disease activity of RA and aggressively treat osteoporosis. Rheumatology anti-osteoporotic agent disease activity osteoporosis rheumatoid arthritis vertebral fracture Figures Figure 1 Figure 2 Introduction Patients with rheumatoid arthritis (RA) are more likely to have osteoporosis than the general population, and RA is considered a risk factor for fragility fractures, including vertebral fractures (VFs) [1-3]. Inflammatory cytokines, activated osteoclasts, and steroids use have been reported as plausible explanations for osteoporosis in RA [1-4]. VFs are associated with a reduced functional status [5-12], and the presence of existing VFs is a risk factor for new VF and other fragile fractures [13, 14]. Therefore, it is important to assess the risk of VFs, particularly in patients with RA. Although the risk of VFs has decreased in RA patients as the arrival of biological agents has dramatically changed the treatment strategy for RA [15], the assessment of the risk of VFs remains important in RA patients. Nevertheless, the epidemiology and risk factors for VFs in patients with RA have not been adequately elucidated. The present study therefore clarified the prevalence and associated factors of VFs in patients with RA. This article was previously posted to the Research Square preprint server on October 26, 2021. Materials And Methods Patients We retrospectively reviewed 426 patients with RA who were treated at an outpatient RA clinic at our university hospital between July 2017 and June 2020. All patients met the American College of Rheumatology classification criteria established in 1987 [16]. Among them, we included 107 patients who underwent lateral radiography of the thoracolumbar spine and dual-energy X-ray absorptiometry (DEXA). Patients with a history of thoracolumbar surgery were excluded (Fig. 1). The research protocol was approved by the Institutional Review Board of Gunma University Hospital (IRB No. HS2019-117), and written informed consent for participation was obtained from all patients. The assessment of VFs We assessed VFs from T4 to L5 using Genant’s semiquantitative classification based on the last available lateral radiograph of the thoracolumbar spine [17]. Vertebral deformities were classified into four grades: grade 0 (normal), grade 1 (mild), grade 2 (moderate), and grade 3 (severe) according to vertebral height reduction (vertebral height reductions of >20% to 25%, >25% to 40%, and >40%). Grade ≥1 was classified as VF in this study. The number of VFs was categorized as 0, 1, 2, or ≥3, according to a previous report [14]. The measurement of the bone mineral density (BMD) We measured the BMD of the femoral neck using DEXA (Discovery A System; Hologic, Inc., Waltham, MA, USA), which was performed within 6 months of the VFs assessment. We also calculated T-scores based on normative data for Asian women. Clinical parameters We collected clinical data within three months of the VF assessment from medical records. The clinical data included the following: age, sex, body mass index (BMI), duration of RA, rheumatoid factor (RF), anti-cyclic citrullinated peptide antibody (ACPA), C-reactive protein (CRP), tender joint count, swollen joint count, visual analog scale (VAS) of patients’ global assessment, and use of medication for RA and osteoporosis for ≥3 months. We further calculated the disease activity score for 28 joints based on C-reactive protein (DAS28-CRP) and the Health Assessment Questionnaire-Disability Index (HAQ-DI) to assess the functional status of patients with RA. Statistical analyses We performed univariate and logistic regression analyses using the STATA/SE software program (version 15; StataCorp, College Station, TX, USA). The Mann-Whitney U test was used to compare continuous data, and the chi-square test or Fisher's exact test was used for categorical variables. To identify associated factors for VFs in RA patients, a logistic regression analysis was performed with VFs as the dependent variable and the age, sex, BMI, history of corticosteroid use, history of biologic use, anti-osteoporotic agent use, DAS28-CRP, and BMD as independent variables. To identify factors associated with the number of VFs in patients with RA, an ordinal logistic regression analysis was also performed with the categorized number of VFs as the dependent variable. Statistical significance was set at P <0.05. Results The demographics and clinical characteristics of the patients with RA in the study population are shown in Table 1. Of the 107 patients with RA, 19 were men, and 88 were women. The mean age was 67.9 years old. The average disease duration was 14.9 years, and the average DAS28-CRP level was 2.2. At the time of the VF assessment, 74 patients (69.2%) had a history of anti-osteoporotic agent use. A total of 95 VFs were identified in 33 patients (30.8%). The VFs showed a bimodal distribution, with peaks at the middle thoracic spine and thoracolumbar junction (Fig. 2). Of the 33 patients with VF, 28 (84.8%) were being treated for osteoporosis. Among those with a history of anti-osteoporotic agent use, 37.8% (28/74) had VFs. There were no significant differences between types of anti-osteoporotic agent based on the prevalence of VFs (active vitamin D3, 39.3%; bisphosphonate, 41.5%; denosumab, 45.5%). As shown in Table 2, in patients with VFs, the DAS28-CRP and the prevalence of a history of corticosteroid use were significantly higher (p = 0.018 and p = 0.004, respectively) and the BMD was significantly lower (p <0.001) than in patients without VFs. A logistic regression analysis revealed that the DAS28-CRP (odds ratio [OR]: 1.816, p = 0.042, 95% confidence interval [CI]: 1.023-3.224) and BMD (OR: 0.358, p = 0.011, 95% CI: 0.161-0.794) were statistically significant factors for VFs in RA patients (Table 3). An ordinal logistic regression analysis revealed that the DAS28-CRP (OR: 1.766, p = 0.036, 95% CI: 1.039-3.000) and BMD (OR: 0.512, p = 0.048, 95% CI: 0.263-0.994) were statistically significant factors associated with the number of VFs in RA patients (Table 4). Discussion Our study has two main findings. First, we determined the prevalence of VFs in patients with RA (30.8%) and found that the prevalence remained almost the same (37.8%), even when patients with RA had a history of guideline-recommended anti-osteoporotic agent use. Second, a high DAS28-CRP and low BMD were independent factors associated with the presence and number of VFs. The prevalence of VFs in patients with RA has been reported to be 13%-45.5%, which is higher than that in the general population or in the control group [4, 18-23]. In our study, the prevalence of VFs in patients with RA was consistent with that reported previously. Of note, the prevalence of VFs in this study remained relatively high in RA patients receiving the anti-osteoporotic agents recommended in the treatment guidelines (activated vitamin D3, bisphosphonate, and denosumab) [24]. To our knowledge, no studies have focused on the prevalence of VFs in patients with RA with a history of anti-osteoporotic agent use. Some studies have reported a relationship between VFs and a high disease activity in RA patients [7, 21, 23, 25]. In line with previous studies, RA disease activity was found to be a risk factor for VFs in patients with RA in this study. Thus, this result suggests that it is important not only to use anti-osteoporotic agents but also to reduce RA disease activity for the prevention of VFs in RA patients. The use of corticosteroids has also been reported to affect VFs [4, 6, 8, 18, 19, 21, 26]. In our study, the use of corticosteroids was a significant factor for VFs in the univariate analysis; however, it was not identified as an independent factor associated with VFs after adjusting for confounders in logistic regression analyses. The relatively low dosage of corticosteroids used in this study may have resulted in our results differing from those of other studies. Anti-rheumatic biological drugs have been reported to prevent bone loss in RA patients [27], and a previous study found that tumor necrosis factor inhibitors were associated with a reduced incidence of VF [28]. In contrast, other reports have demonstrated that biological agents do not contribute to increased BMD or reduce the risk of fractures [29, 30]. In this study, we found no significant association between the use of biologics and VFs. Several limitations associated with the present study warrant mention. First, there may have been some selection bias, as this was a retrospective study. In this study, we only included patients who underwent an assessment of VFs and osteoporosis. Second, we lacked baseline data on VFs in patients with RA. It is possible that the presence of VFs before the diagnosis of RA influenced the results of this study. However, given the age of onset of RA, we assume that the majority of VFs in this study occurred after the diagnosis of RA, since the prevalence of VFs in the Japanese general population under 60 years old is <10% [12]. Third, the study population was relatively small. Thus, the statistical power may have been insufficient for some of the investigated factors. Despite these limitations, we believe that this study provides significant information regarding the treatment strategy for RA. Conclusions We retrospectively investigated the number and location of VFs, BMD, the RA disease activity score, and a history of RA and osteoporosis medication. Furthermore, we assessed the prevalence of VFs in patients with RA and the association between the clinical parameters of RA patients and VFs. We found that the prevalence of VFs in patients with RA was relatively high, regardless of the use of anti-osteoporotic agents. The presence and number of VFs in patients were associated with a high disease activity and low BMD. Based on these findings, to reduce VFs in RA patients, it is important to tightly control the disease activity of RA and aggressively treat osteoporosis. References 1. Haugeberg G, Uhlig T, Falch JA, et al. Bone mineral density and frequency of osteoporosis in female patients with rheumatoid arthritis: results from 394 patients in the Oslo County Rheumatoid Arthritis register. Arthritis Rheum. 2000, 43:522-30. 2. van Staa TP, Geusens P, Bijlsma JW, et al. 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Characteristics of the RA patients in the study population N=107 Value Age (years), mean ± SD 67.9 ± 10.9 Female, n (%) 88 (82.2) BMI (kg/m² ） , mean ± SD 23.3 ± 3.9 Disease duration (years), mean ± SD 14.9 ± 11.2 RF positivity, % 69.3 ACPA positivity, % 77.6 Steinbrocker class (1/2/3/4) 17/65/24/1 Steinbrocker stage (Ⅰ/Ⅱ/Ⅲ/Ⅳ) 14/21/39/33 Tender joint count, 28 joints 1.6 ± 3.0 Swollen joint count, 28 joints 1.0 ± 2.8 Global assessment score 22.7 ± 24.7 CRP (mg/dl) 0.4 ± 0.5 DAS28-CRP 2.2 ± 1.0 MTX use, n (%) 85 (79.4) History of corticosteroid use, n (%) 66 (61.7) Current users, n 47 Daily dose for current users (mg/day), mean ± SD 3.9 ± 2.4 Long users (≥12months), n 61 History of biologic agent use, n (%) 61 (57.0) TNF inhibitor, n 46 Tocilizumab, n 26 Abatacept, n 17 Anti-osteoporotic agent use, n (%) 74 (69.2) Activate vitamin D3, n 56 Bisphosphonate, n 41 Denosumab, n 22 Prevalence of vertebral fracture, n (%) 33 (30.8) Number of vertebral fractures 1, n 15 2, n 10 ≥3, n 8 BMD (T-score at femoral neck) -2.0 ± 1.0 HAQ-DI 0.8 ± 0.8 ACPA, anti-cyclic citrullinated peptide antibody; BMD, bone mineral density; BMI, body mass index; CRP, C-reactive protein; DAS28-CRP, disease activity score for 28 joints based on C-reactive protein; ESR, erythrocyte sedimentation rate; HAQ-DI, Health Assessment Questionnaire-Disability Index ; MTX, methotrexate; RA, rheumatoid arthritis; RF, rheumatoid factor; SD, standard deviation; TNF, tumor necrosis factor Table 2. Demographic and clinical parameters of RA patients with and without vertebral fractures without vertebral fractures (n=74) with vertebral fractures (n=33) p value Age, years 67.0 ± 11.8 70.2 ± 8.5 0.254 Female, n (%) 61 (82.4) 27 (81.8) 0.939 BMI, kg/m² 23.5 ± 4.0 23.0 ± 3.6 0.791 Disease duration of RA, years 13.8 ± 10.4 17.1 ± 12.5 0.248 Tender joint count, 28 joints 1.1 ± 1.8 2.7 ± 4.6 0.155 Swollen joint count, 28 joints 0.8 ± 2.8 1.3 ± 2.6 0.351 Global assessment score 19.2 ± 20.7 31.0 ± 31.2 0.190 CRP, mg/dl 0.31 ± 0.53 0.45 ± 0.57 0.216 DAS28-CRP 2.1 ± 0.9 2.7 ± 1.2 0.018 History of corticosteroid use, n (%) 39 (52.7) 27 (81.8) 0.004 History of biologic agent use, n (%) 38 (51.4) 23 (69.7) 0.078 Anti-osteoporotic agent use, n (%) 46 (62.2) 28 (84.8) 0.020 Activate vitamin D3, n 34 22 Bisphosphonate, n 24 17 Denosumab, n 12 10 BMD (T-score at femoral neck) -1.7 ± 1.0 -2.5 ± 0.9 < 0.001 HAQ-DI 0.6 ± 0.7 1.0 ± 1.0 0.111 BMD, bone mineral density; BMI, body mass index; CRP, C-reactive protein; DAS28-CRP, disease activity score for 28 joints based on C-reactive protein ; ESR, erythrocyte sedimentation rate; HAQ-DI, Health Assessment Questionnaire-Disability Index; RA, rheumatoid arthritis. Table 3. Logistic regression model of factors associated with vertebral fractures in RA patients OR 95% CI p value Age 0.989 0.931-1.052 0.732 Female 2.384 0.513-11.081 0.268 BMI 1.063 0.919-1.229 0.411 History of corticosteroid use 0.622 0.141-2.738 0.530 History of biologic agent use 1.594 0.477-5.332 0.449 Anti-osteoporotic agent use 4.624 0.743-28.764 0.101 DAS28-CRP 1.816 1.023-3.224 0.042 BMD (T-score at femoral neck) 0.358 0.161-0.794 0.011 BMD, bone mineral density; BMI, body mass index; DAS28, disease activity score for 28 joints based on C-reactive protein; OR, Odds ratio; 95% CI, 95% confidence interval; RA, rheumatoid arthritis. Table 4. Ordinal logistic regression model of factors associated with the number of vertebral fractures in RA patients OR 95% CI p value Age 1.017 0.962-1.076 0.550 Female 2.404 0.529-10.920 0.256 BMI 1.023 0.896-1.168 0.734 History of corticosteroid use 0.706 0.175-2.855 0.625 History of biologic agent use 1.566 0.518-4.733 0.427 Anti-osteoporotic agent use 4.652 0.735-29.460 0.103 DAS28-CRP 1.766 1.039-3.000 0.036 BMD (T-score at femoral neck) 0.512 0.263-0.994 0.048 BMD, bone mineral density; BMI, body mass index; 95% CI, 95% confidence interval; DAS28-CRP, disease activity score for 28 joints based on C-reactive protein; OR, Odds ratio; RA, rheumatoid arthritis. Declarations Funding There has been no significant financial support for this work that could have influenced its outcome. The authors acknowledge the financial support provided by a UCB Japan Grant (UCBJ Grant) for the English proofreading and article processing charge of the journal. Availability of data and materials All data generated or analyzed during this study are included in this published article. Authors' contributions HS and KO made substantial contributions to the design of the study, acquisition, analysis, interpretation of data and writing of the manuscript. YI participated in the design of the study, acquiring data, helped to draft the manuscript and contributed to revising the manuscript critically. AH, ET, TM, SI and KI participated in acquiring data and critically contributing to revising the manuscript. TS, TK and YY contributed to revising the manuscript critically. HC critically contributed to revising the manuscript enhancing its intellectual content and approving the final content of the manuscript. All authors read and approved the final manuscript. Ethics approval and consent to participate Ethical approval was obtained from the institutional review board of the Gunma University Hospital. Patients provided written informed consent before taking part in this study. Competing interests The authors declare that they have no competing interests. Competing interests The authors declare no conflicts of interest in association with the present study. Acknowledgments None. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 2 posted You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-942051","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":59281675,"identity":"02ead8f0-a8de-4aed-96ba-044ef62ae50a","order_by":0,"name":"Hideo Sakane","email":"","orcid":"","institution":"Gunma University Graduate School of Medicine School of Medicine: Gunma Daigaku Daigakuin Igakukei Kenkyuka Igakubu","correspondingAuthor":false,"prefix":"","firstName":"Hideo","middleName":"","lastName":"Sakane","suffix":""},{"id":59281676,"identity":"2620848b-ad74-4d6a-a0cd-5472361c27c8","order_by":1,"name":"Koichi Okamura","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA60lEQVRIiWNgGAWjYBACCQY2CIMfTZgILZINJGsxOECswyTb2xI/3Wy7J298fo3Zoxs1DIkN7IcfMFjuwK1FmufYYenctmLDbTfemBvnHANq4UkzYJA8g1uLnER6A1BLAuO2G2fMpHPY/ic2MOQALW/Dq6X5N1CL/eYZIC3/gLbwv8GvRVoi7RjIlsQN/D1mQAZQiwQBWyR7jqVZ55xLSJ5xg61MOrePwbhN4pnBAXx+kTjeZnw7pyzBtr//8DbpnG8Msv38yQ8fS+IJMSTNCRAaFE+HUSMWF+A/gGAzfiRKyygYBaNgFIwQAAD4gk0ozmxQjAAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0003-4523-7514","institution":"Gunma University","correspondingAuthor":true,"prefix":"","firstName":"Koichi","middleName":"","lastName":"Okamura","suffix":""},{"id":59281677,"identity":"e1c9c635-6183-4d99-b47d-e012a2d508f5","order_by":2,"name":"Yoichi Iizuka","email":"","orcid":"","institution":"Gunma Daigaku","correspondingAuthor":false,"prefix":"","firstName":"Yoichi","middleName":"","lastName":"Iizuka","suffix":""},{"id":59281678,"identity":"46a36ebe-40c8-45ac-8538-43eff43a3286","order_by":3,"name":"Akira Honda","email":"","orcid":"","institution":"Gunma University: Gunma Daigaku","correspondingAuthor":false,"prefix":"","firstName":"Akira","middleName":"","lastName":"Honda","suffix":""},{"id":59281679,"identity":"9b48e4fe-b5ba-487f-a656-f99226bc68cf","order_by":4,"name":"Eiji Takasawa","email":"","orcid":"","institution":"Gunma Daigaku","correspondingAuthor":false,"prefix":"","firstName":"Eiji","middleName":"","lastName":"Takasawa","suffix":""},{"id":59281680,"identity":"e1d45b8c-fe06-4d14-aba7-2c3e18f2c01e","order_by":5,"name":"Tokue Mieda","email":"","orcid":"","institution":"Gunma Daigaku","correspondingAuthor":false,"prefix":"","firstName":"Tokue","middleName":"","lastName":"Mieda","suffix":""},{"id":59281684,"identity":"19a488a6-9842-4ef3-9968-f9bec2c89d16","order_by":6,"name":"Yukio Yonemoto","email":"","orcid":"","institution":"Inoue Hospital: Inoue Byoin","correspondingAuthor":false,"prefix":"","firstName":"Yukio","middleName":"","lastName":"Yonemoto","suffix":""},{"id":59281685,"identity":"0cf400f3-14d2-4cd3-ae40-190eed927b08","order_by":7,"name":"Takahito Suto","email":"","orcid":"","institution":"Gunma University: Gunma Daigaku","correspondingAuthor":false,"prefix":"","firstName":"Takahito","middleName":"","lastName":"Suto","suffix":""},{"id":59281686,"identity":"0b61035f-d385-4a56-b4f9-e761e249b29f","order_by":8,"name":"Tetsuya Kaneko","email":"","orcid":"","institution":"Fukaya Red Cross Hospital: Fukaya Sekijuji Byoin","correspondingAuthor":false,"prefix":"","firstName":"Tetsuya","middleName":"","lastName":"Kaneko","suffix":""},{"id":59281687,"identity":"44356d95-ebca-4e12-9eea-64a10cc310a7","order_by":9,"name":"Hirotaka Chikuda","email":"","orcid":"","institution":"Gunma University Graduate School of Medicine School of Medicine: Gunma Daigaku Daigakuin Igakukei Kenkyuka Igakubu","correspondingAuthor":false,"prefix":"","firstName":"Hirotaka","middleName":"","lastName":"Chikuda","suffix":""}],"badges":[],"createdAt":"2021-09-27 10:33:58","currentVersionCode":2,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-942051/v2","doiUrl":"https://doi.org/10.21203/rs.3.rs-942051/v2","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":49288862,"identity":"ce90e180-c933-4753-a6cd-b42c667f2a1e","added_by":"auto","created_at":"2024-01-08 03:45:24","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":115163,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram of the present study\u003c/p\u003e\n\u003cp\u003eACR, American Rheumatism Association; RA, rheumatoid arthritis\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-942051/v2/cc4b18e402f169774981d68c.png"},{"id":49288863,"identity":"6cdf8376-7b8a-4e0b-95ca-308e4bab4f6e","added_by":"auto","created_at":"2024-01-08 03:45:24","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":33277,"visible":true,"origin":"","legend":"\u003cp\u003eNumber of vertebral fractures in patients with RA\u003c/p\u003e\n\u003cp\u003eRA, rheumatoid arthritis\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-942051/v2/4c412b86d0c02c9e366c8577.png"},{"id":49289117,"identity":"c1256a0f-94a2-4544-a646-34fe15793375","added_by":"auto","created_at":"2024-01-08 03:53:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":381159,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-942051/v2/8debb76c-3936-426f-b68e-64b60f85a56a.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eHigh disease activity influences the presence of vertebral fractures in rheumatoid arthritis\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePatients with rheumatoid arthritis (RA) are more likely to have osteoporosis than the general population, and RA is considered a risk factor for fragility fractures, including vertebral fractures (VFs) [1-3]. Inflammatory cytokines, activated osteoclasts, and steroids use have been reported as plausible explanations for osteoporosis in RA [1-4].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVFs are associated with a reduced functional status [5-12], and the presence of existing VFs is a risk factor for new VF and other fragile fractures [13, 14]. Therefore, it is important to assess the risk of VFs, particularly in patients with RA.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAlthough the risk of VFs has decreased in RA patients as the arrival of biological agents has dramatically changed the treatment strategy for RA [15], the assessment of the risk of VFs remains important in RA patients. Nevertheless, the epidemiology and risk factors for VFs in patients with RA have not been adequately elucidated.\u003c/p\u003e\n\u003cp\u003eThe present study therefore clarified the prevalence and associated factors of VFs in patients with RA.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;This article was previously posted to the Research Square preprint server on October 26, 2021.\u003c/p\u003e"},{"header":"Materials And Methods","content":"\u003cp\u003e\u003cem\u003ePatients\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe retrospectively reviewed 426 patients with RA who were treated at an outpatient RA clinic at our university hospital between July 2017 and June 2020. All patients met the American College of Rheumatology classification criteria established in 1987 [16]. Among them, we included 107 patients who underwent lateral radiography of the thoracolumbar spine and dual-energy X-ray absorptiometry (DEXA). Patients with a history of thoracolumbar surgery were excluded (Fig. 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe research protocol was approved by the Institutional Review Board of Gunma University Hospital (IRB No. HS2019-117), and written informed consent for participation was obtained from all patients.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe assessment of VFs\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe assessed VFs from T4 to L5 using Genant\u0026rsquo;s semiquantitative classification based on the last available lateral radiograph of the thoracolumbar spine [17]. Vertebral deformities were classified into four grades: grade 0 (normal), grade 1 (mild), grade 2 (moderate), and grade 3 (severe) according to vertebral height reduction (vertebral height reductions of \u0026gt;20% to 25%, \u0026gt;25% to 40%, and \u0026gt;40%). Grade \u0026ge;1 was classified as VF in this study. The number of VFs was categorized as 0, 1, 2, or \u0026ge;3, according to a previous report [14].\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe measurement of the bone mineral density (BMD)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe measured the BMD of the femoral neck using DEXA (Discovery A System; Hologic, Inc., Waltham, MA, USA), which was performed within 6 months of the VFs assessment. We also calculated T-scores based on normative data for Asian women.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eClinical parameters \u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe collected clinical data within three months of the VF assessment from medical records. The clinical data included the following: age, sex, body mass index (BMI), duration of RA, rheumatoid factor (RF), anti-cyclic citrullinated peptide antibody (ACPA), C-reactive protein (CRP), tender joint count, swollen joint count, visual analog scale (VAS) of patients\u0026rsquo; global assessment, and use of medication for RA and osteoporosis for \u0026ge;3 months. We further calculated the disease activity score for 28 joints based on C-reactive protein (DAS28-CRP) and the Health Assessment Questionnaire-Disability Index (HAQ-DI) to assess the functional status of patients with RA.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStatistical analyses\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe performed univariate and logistic regression analyses using the STATA/SE software program (version 15; StataCorp, College Station, TX, USA). The Mann-Whitney U test was used to compare continuous data, and the chi-square test or Fisher\u0026apos;s exact test was used for categorical variables. To identify associated factors for VFs in RA patients, a logistic regression analysis was performed with VFs as the dependent variable and the age, sex, BMI, history of corticosteroid use, history of biologic use, anti-osteoporotic agent use, DAS28-CRP, and BMD as independent variables. To identify factors associated with the number of VFs in patients with RA, an ordinal logistic regression analysis was also performed with the categorized number of VFs as the dependent variable. Statistical significance was set at P \u0026lt;0.05.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe demographics and clinical characteristics of the patients with RA in the study population are shown in Table 1. Of the 107 patients with RA, 19 were men, and 88 were women. The mean age was 67.9 years old. The average disease duration was 14.9 years, and the average DAS28-CRP level was 2.2.\u003c/p\u003e\n\u003cp\u003eAt the time of the VF assessment, 74 patients (69.2%) had a history of anti-osteoporotic agent use. A total of 95 VFs were identified in 33 patients (30.8%). The VFs showed a bimodal distribution, with peaks at the middle thoracic spine and thoracolumbar junction (Fig. 2). Of the 33 patients with VF, 28 (84.8%) were being treated for osteoporosis. Among those with a history of anti-osteoporotic agent use, 37.8% (28/74) had VFs. There were no significant differences between types of anti-osteoporotic agent based on the prevalence of VFs (active vitamin D3, 39.3%; bisphosphonate, 41.5%; denosumab, 45.5%).\u003c/p\u003e\n\u003cp\u003eAs shown in Table 2, in patients with VFs, the DAS28-CRP and the prevalence of a history of corticosteroid use were significantly higher (p = 0.018 and p = 0.004, respectively) and the BMD was significantly lower (p \u0026lt;0.001) than in patients without VFs.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA logistic regression analysis revealed that the DAS28-CRP (odds ratio [OR]: 1.816, p = 0.042, 95% confidence interval [CI]: 1.023-3.224) and BMD (OR: 0.358, p = 0.011, 95% CI: 0.161-0.794) were statistically significant factors for VFs in RA patients (Table 3). An ordinal logistic regression analysis revealed that the DAS28-CRP (OR: 1.766, p = 0.036, 95% CI: 1.039-3.000) and BMD (OR: 0.512, p = 0.048, 95% CI: 0.263-0.994) were statistically significant factors associated with the number of VFs in RA patients (Table 4).\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study has two main findings. First, we determined the prevalence of VFs in patients with RA (30.8%) and found that the prevalence remained almost the same (37.8%), even when patients with RA had a history of guideline-recommended anti-osteoporotic agent use. Second, a high DAS28-CRP and low BMD were independent factors associated with the presence and number of VFs.\u003c/p\u003e\n\u003cp\u003eThe prevalence of VFs in patients with RA has been reported to be 13%-45.5%, which is higher than that in the general population or in the control group [4, 18-23]. In our study, the prevalence of VFs in patients with RA was consistent with that reported previously. Of note, the prevalence of VFs in this study remained relatively high in RA patients receiving the anti-osteoporotic agents recommended in the treatment guidelines (activated vitamin D3, bisphosphonate, and denosumab) [24]. To our knowledge, no studies have focused on the prevalence of VFs in patients with RA with a history of anti-osteoporotic agent use.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSome studies have reported a relationship between VFs and a high disease activity in RA patients [7, 21, 23, 25]. In line with previous studies, RA disease activity was found to be a risk factor for VFs in patients with RA in this study. Thus, this result suggests that it is important not only to use anti-osteoporotic agents but also to reduce RA disease activity for the prevention of VFs in RA patients.\u003c/p\u003e\n\u003cp\u003eThe use of corticosteroids has also been reported to affect VFs [4, 6, 8, 18, 19, 21, 26]. In our study, the use of corticosteroids was a significant factor for VFs in the univariate analysis; however, it was not identified as an independent factor associated with VFs after adjusting for confounders in logistic regression analyses. The relatively low dosage of corticosteroids used in this study may have resulted in our results differing from those of other studies.\u003c/p\u003e\n\u003cp\u003eAnti-rheumatic biological drugs have been reported to prevent bone loss in RA patients [27], and a previous study found that tumor necrosis factor inhibitors were associated with a reduced incidence of VF [28]. In contrast, other reports have demonstrated that biological agents do not contribute to increased BMD or reduce the risk of fractures [29, 30]. In this study, we found no significant association between the use of biologics and VFs.\u003c/p\u003e\n\u003cp\u003eSeveral limitations associated with the present study warrant mention. First, there may have been some selection bias, as this was a retrospective study. In this study, we only included patients who underwent an assessment of VFs and osteoporosis. Second, we lacked baseline data on VFs in patients with RA. It is possible that the presence of VFs before the diagnosis of RA influenced the results of this study. However, given the age of onset of RA, we assume that the majority of VFs in this study occurred after the diagnosis of RA, since the prevalence of VFs in the Japanese general population under 60 years old is \u0026lt;10% [12]. Third, the study population was relatively small. Thus, the statistical power may have been insufficient for some of the investigated factors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDespite these limitations, we believe that this study provides significant information regarding the treatment strategy for RA.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eWe retrospectively investigated the number and location of VFs, BMD, the RA disease activity score, and a history of RA and osteoporosis medication. Furthermore, we assessed the prevalence of VFs in patients with RA and the association between the clinical parameters of RA patients and VFs. We found that the prevalence of VFs in patients with RA was relatively high, regardless of the use of anti-osteoporotic agents. The presence and number of VFs in patients were associated with a high disease activity and low BMD. Based on these findings, to reduce VFs in RA patients, it is important to tightly control the disease activity of RA and aggressively treat osteoporosis.\u003c/p\u003e"},{"header":"References","content":"\u003cp\u003e1. Haugeberg G, Uhlig T, Falch JA, et al. Bone mineral density and frequency of osteoporosis in female patients with rheumatoid arthritis: results from 394 patients in the Oslo County Rheumatoid Arthritis register. Arthritis Rheum. 2000, 43:522-30.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2. van Staa TP, Geusens P, Bijlsma JW, et al. Clinical assessment of the long-term risk of fracture in patients with rheumatoid arthritis. Arthritis Rheum. 2006, 54:3104-12.\u003c/p\u003e\n\u003cp\u003e3. Wright NC, Lisse JR, Walitt BT, et al. Women\u0026apos;s Health Initiative Investigators. Arthritis increases the risk for fractures--results from the Women\u0026apos;s Health Initiative. J Rheumatol. 2011, 38:1680-8.\u003c/p\u003e\n\u003cp\u003e4. \u0026Oslash;rstavik RE, Haugeberg G, Mowinckel P, et al. Vertebral deformities in rheumatoid arthritis: a comparison with population-based controls. Arch Intern Med. 2004, 164:420-5.\u003c/p\u003e\n\u003cp\u003e5. Nampei A, Hashimoto J, Koyanagi J, et al. Characteristics of fracture and related factors in patients with rheumatoid arthritis. Mod Rheumatol. 2008, 18:170-6.\u003c/p\u003e\n\u003cp\u003e6. Furuya T, Kotake S, Inoue E, et al. Risk factors associated with incident fractures in Japanese men with rheumatoid arthritis: a prospective observational cohort study. J Bone Miner Metab. 2008, 26:499-505.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e7. Dirven L, van den Broek M, van Groenendael JH, et al. Prevalence of vertebral fractures in a disease activity steered cohort of patients with early active rheumatoid arthritis. BMC Musculoskelet Disord. 2012, 13:125.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e8. Ishida O, Furuya T, Inoue E, et al. Risk factors for established vertebral fractures in Japanese patients with rheumatoid arthritis: Results from a large prospective observational cohort study. Mod Rheumatol. 2015, 25:373-8.\u003c/p\u003e\n\u003cp\u003e9. Omata Y, Hagiwara F, Nishino J, et al. Vertebral fractures affect functional status in postmenopausal rheumatoid arthritis patients. J Bone Miner Metab. 2014, 32:725-31.\u003c/p\u003e\n\u003cp\u003e10. Cho SK, Lee JH, Han M, et al. The influence of vertebral fracture on the functional disability of patients with rheumatoid arthritis. J Korean Med Sci. 2014, 29:859-63.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e11. Phuan-Udom R, Lektrakul N, Katchamart W. The association between 10-year fracture risk by FRAX and osteoporotic fractures with disease activity in patients with rheumatoid arthritis. Clin Rheumatol. 2018, 37:2603-2610.\u003c/p\u003e\n\u003cp\u003e12. Horii C, Asai Y, Iidaka T, et al. Differences in prevalence and associated factors between mild and severe vertebral fractures in Japanese men and women: the third survey of the ROAD study. J Bone Miner Metab. 2019, 37:844-853.\u003c/p\u003e\n\u003cp\u003e13. Lindsay R, Silverman SL, Cooper C, et al. Risk of new vertebral fracture in the year following a fracture. JAMA. 2001, 85:320-3.\u003c/p\u003e\n\u003cp\u003e14. Delmas PD, Genant HK, Crans GG, et al. Severity of prevalent vertebral fractures and the risk of subsequent vertebral and nonvertebral fractures: results from the MORE trial. Bone. 2003, 33:522-32.\u003c/p\u003e\n\u003cp\u003e15. Zerbini CAF, Clark P, Mendez-Sanchez L, et al. Biologic therapies and bone loss in rheumatoid arthritis. Osteoporos Int. 2017, 28:429-446.\u003c/p\u003e\n\u003cp\u003e16. Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988, 31:315-24.\u003c/p\u003e\n\u003cp\u003e17. Genant HK, Wu CY, van Kuijk C, et al. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. 1993, 8:1137-48.\u003c/p\u003e\n\u003cp\u003e18. \u0026Oslash;rstavik RE, Haugeberg G, Uhlig T, et al. Vertebral deformities in 229 female patients with rheumatoid arthritis: associations with clinical variables and bone mineral density. Arthritis Rheum. 2003, 49:355-60.\u003c/p\u003e\n\u003cp\u003e19. Tong JJ, Xu SQ, Zong HX, et al. Prevalence and risk factors associated with vertebral osteoporotic fractures in patients with rheumatoid arthritis. Clin Rheumatol. 2020, 39:357-364.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e20. Okano T, Inui K, Tada M, et al. High frequency of vertebral fracture and low bone quality in patients with rheumatoid arthritis-Results from TOMORROW study. Mod Rheumatol. 2017, 27:398-404.\u003c/p\u003e\n\u003cp\u003e21. Gua\u0026ntilde;abens N, Olmos JM, Hern\u0026aacute;ndez JL, et. al. Vertebral fractures are increased in rheumatoid arthritis despite recent therapeutic advances: a case-control study. Osteoporos Int. 2021, 32:1333-1342.\u003c/p\u003e\n\u003cp\u003e22. Kishimoto Y, Kato Y, Uemura M, Kuranobu K. Incidence and predictors of fragility fracture in postmenopausal rheumatoid arthritis patients receiving oral bisphosphonates: a longitudinal observational study. BMC Rheumatol. 2022, 6:8.\u003c/p\u003e\n\u003cp\u003e23. Mohammad A, Lohan D, Bergin D, et al. The prevalence of vertebral fracture on vertebral fracture assessment imaging in a large cohort of patients with rheumatoid arthritis. Rheumatology (Oxford). 2014, 53:821-7.\u003c/p\u003e\n\u003cp\u003e24. Japan Osteoporosis Society, 2015 Guideline for the treatment of osteoporosis (Japanese). Available from:\u0026nbsp;\u003ca href=\"http://www.josteo.com/ja/guideline/doc/15_1.pdf\"\u003ehttp://www.josteo.com/ja/guideline/doc/15_1.pdf\u003c/a\u003e\u003c/p\u003e\n\u003cp\u003e25. El Maghraoui A, Rezqi A, Mounach A, et al. Prevalence and risk factors of vertebral fractures in women with rheumatoid arthritis using vertebral fracture assessment. Rheumatology (Oxford). 2010, 49:1303-10.\u003c/p\u003e\n\u003cp\u003e26. Kim D, Cho SK, Park B, et al. Glucocorticoids Are Associated with an Increased Risk for Vertebral Fracture in Patients with Rheumatoid Arthritis. J Rheumatol. 2018, 45:612-620.\u003c/p\u003e\n\u003cp\u003e27. Chen JF, Hsu CY, Yu SF, et al. The impact of long-term biologics/target therapy on bone mineral density in rheumatoid arthritis: a propensity score-matched analysis. Rheumatology (Oxford). 2020, 59:2471-2480.\u003c/p\u003e\n\u003cp\u003e28. Ozen G, Pedro S, Wolfe F, et al. Medications associated with fracture risk in patients with rheumatoid arthritis. Ann Rheum Dis. 2019, 78:1041-1047.\u003c/p\u003e\n\u003cp\u003e29. Lee JS, Lim DH, Oh JS, et al. Effect of TNF inhibitors on bone mineral density in rheumatoid arthritis patients receiving bisphosphonate: a retrospective cohort study. Rheumatol Int. 2020, 40:481-487.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e30. Di Munno O, Ferro F. The effect of biologic agents on bone homeostasis in chronic inflammatory rheumatic diseases. Clin Exp Rheumatol 2019, 37:502-507.\u003c/p\u003e"},{"header":"Tables","content":"\u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eTable 1.\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eCharacteristics of the RA patients in the study population\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"border: none;width:356.25pt;border-collapse:collapse;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:260.0pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;N=107\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.25pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"MS PGothic\",sans-serif;'\u003e \u003c/span\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eValue\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:260.0pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eAge (years), mean \u0026plusmn; SD\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.25pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e67.9 \u0026plusmn; 10.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:260.0pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eFemale, n (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.25pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e88 (82.2)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:260.0pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eBMI (kg/m\u0026sup2;\u003c/span\u003e\u003cspan style='font-size:16px;font-family:\"MS PGothic\",sans-serif;'\u003e）\u003c/span\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e, mean \u0026plusmn; SD\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.25pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e23.3 \u0026plusmn; 3.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:260.0pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eDisease duration (years), mean \u0026plusmn; SD\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.25pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e14.9 \u0026plusmn; 11.2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:260.0pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eRF positivity, %\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.25pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e69.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:260.0pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eACPA positivity, %\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.25pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e77.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:260.0pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eSteinbrocker class (1/2/3/4)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.25pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e17/65/24/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:260.0pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eSteinbrocker stage (Ⅰ/Ⅱ/Ⅲ/Ⅳ)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.25pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e14/21/39/33\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:260.0pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eTender joint count, 28 joints\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.25pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.6 \u0026plusmn; 3.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:260.0pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eSwollen joint count, 28 joints\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.25pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.0 \u0026plusmn; 2.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:260.0pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eGlobal assessment score\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.25pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e22.7 \u0026plusmn; 24.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:260.0pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eCRP (mg/dl)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.25pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.4 \u0026plusmn; 0.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:260.0pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eDAS28-CRP\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.25pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e2.2 \u0026plusmn; 1.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:260.0pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eMTX use, n (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.25pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e85 (79.4)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:260.0pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eHistory of corticosteroid use, n (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.25pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e66 (61.7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:260.0pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"MS PGothic\",sans-serif;'\u003e \u003c/span\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eCurrent users, n\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.25pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e47\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:260.0pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"MS PGothic\",sans-serif;'\u003e \u003c/span\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eDaily dose for current users (mg/day), mean \u0026plusmn; SD\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.25pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e3.9 \u0026plusmn; 2.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:260.0pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"MS PGothic\",sans-serif;'\u003e \u003c/span\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eLong users (\u0026ge;12months), n\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.25pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e61\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:260.0pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eHistory of biologic agent use, n (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.25pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e61 (57.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:260.0pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;TNF inhibitor, n\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.25pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e46\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:260.0pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;Tocilizumab, n\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.25pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e26\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:260.0pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;Abatacept, n\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.25pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e17\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:260.0pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eAnti-osteoporotic agent use, n (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.25pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e74 (69.2)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:260.0pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;Activate vitamin D3, n\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.25pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e56\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:260.0pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;Bisphosphonate, n\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.25pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e41\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:260.0pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;Denosumab, n\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.25pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e22\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:260.0pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003ePrevalence of vertebral fracture, n (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.25pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e33 (30.8)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:260.0pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eNumber of vertebral fractures\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.25pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:260.0pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;1, n\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.25pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e15\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:260.0pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;2, n\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.25pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e10\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:260.0pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u0026ge;3, n\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.25pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:260.0pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eBMD (T-score at femoral neck)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.25pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e-2.0 \u0026plusmn; 1.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:260.0pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eHAQ-DI\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.25pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 4.95pt 0in 4.95pt;height:13.5pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.8 \u0026plusmn; 0.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eACPA, anti-cyclic citrullinated peptide antibody; BMD, bone mineral density; BMI, body mass index; CRP, C-reactive protein; DAS28-CRP,\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003edisease activity score for 28 joints based on C-reactive protein;\u003c/span\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;ESR, erythrocyte sedimentation rate; HAQ-DI, Health Assessment Questionnaire-Disability Index\u003c/span\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e;\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eMTX, methotrexate; RA, rheumatoid arthritis; RF, rheumatoid factor; SD, standard deviation; TNF, tumor necrosis factor\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cbr\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eTable 2.\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eDemographic and clinical parameters of RA patients with and without vertebral fractures\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"border: none;width:508.55pt;border-collapse:collapse;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:163.05pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 4.95pt 0in 4.95pt;height:18.6pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"MS PGothic\",sans-serif;color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 4.95pt 0in 4.95pt;height:18.6pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003ewithout vertebral fractures (n=74)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 4.95pt 0in 4.95pt;height:18.6pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003ewith vertebral fractures (n=33)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.2pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 4.95pt 0in 4.95pt;height:18.6pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cem\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003ep\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;value\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:163.05pt;border:none;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003eAge, years\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;border:none;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e67.0 \u0026plusmn; 11.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;border:none;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e70.2 \u0026plusmn; 8.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.2pt;border:none;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.254\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:163.05pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003eFemale, n (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e61 (82.4)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e27 (81.8)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.2pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.939\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:163.05pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003eBMI, kg/m\u0026sup2;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e23.5 \u0026plusmn; 4.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e23.0 \u0026plusmn; 3.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.2pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.791\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:163.05pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003eDisease duration of RA, years\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e13.8 \u0026plusmn; 10.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e17.1 \u0026plusmn; 12.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.2pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.248\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:163.05pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003eTender joint count, 28 joints\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e1.1 \u0026plusmn; 1.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e2.7 \u0026plusmn; 4.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.2pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.155\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:163.05pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003eSwollen joint count, 28 joints\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.8 \u0026plusmn; 2.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e1.3 \u0026plusmn; 2.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.2pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.351\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:163.05pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003eGlobal assessment score\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e19.2 \u0026plusmn; 20.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e31.0 \u0026plusmn; 31.2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.2pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.190\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:163.05pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003eCRP, mg/dl\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.31 \u0026plusmn; 0.53\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.45 \u0026plusmn; 0.57\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.2pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.216\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:163.05pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003eDAS28-CRP\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e2.1 \u0026plusmn; 0.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e2.7 \u0026plusmn; 1.2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.2pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.018\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:163.05pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003eHistory of corticosteroid use, n (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e39 (52.7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e27 (81.8)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.2pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.004\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:163.05pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003eHistory of biologic agent use, n (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e38 (51.4)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e23 (69.7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.2pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.078\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:163.05pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003eAnti-osteoporotic agent use, n (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e46 (62.2)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e28 (84.8)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.2pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.020\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:163.05pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;Activate vitamin D3, n\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e34\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e22\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.2pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:163.05pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;Bisphosphonate, n\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e24\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e17\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.2pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:163.05pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;Denosumab, n\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e12\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e10\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.2pt;padding:0in 4.95pt 0in 4.95pt;height:.25in;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:163.05pt;padding:0in 4.95pt 0in 4.95pt;height:18.6pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003eBMD (T-score at femoral neck)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;padding:0in 4.95pt 0in 4.95pt;height:18.6pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e-1.7 \u0026plusmn; 1.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;padding:0in 4.95pt 0in 4.95pt;height:18.6pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e-2.5 \u0026plusmn; 0.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.2pt;padding:0in 4.95pt 0in 4.95pt;height:18.6pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026lt; 0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:163.05pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 4.95pt 0in 4.95pt;height:18.6pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003eHAQ-DI\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 4.95pt 0in 4.95pt;height:18.6pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.6 \u0026plusmn; 0.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:124.65pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 4.95pt 0in 4.95pt;height:18.6pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e1.0 \u0026plusmn; 1.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.2pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 4.95pt 0in 4.95pt;height:18.6pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.111\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eBMD, bone mineral density; BMI, body mass index; CRP, C-reactive protein; DAS28-CRP,\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003edisease activity score for 28 joints based on C-reactive protein\u003c/span\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e; ESR, erythrocyte sedimentation rate; HAQ-DI, Health Assessment Questionnaire-Disability Index; RA, rheumatoid arthritis.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cbr\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eTable 3.\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eLogistic regression model of factors associated with vertebral fractures in RA patients\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155.7pt;border-width: 1pt medium;border-style: solid none;border-color: windowtext currentcolor;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 58.05pt;border-width: 1pt medium;border-style: solid none;border-color: windowtext currentcolor;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eOR\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133.55pt;border-width: 1pt medium;border-style: solid none;border-color: windowtext currentcolor;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e95% CI\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border-width: 1pt medium;border-style: solid none;border-color: windowtext currentcolor;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cem\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003ep\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;value\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155.7pt;border: medium;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eAge\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.05pt;border: medium;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.989\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133.55pt;border: medium;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.931-1.052\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: medium;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.732\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155.7pt;border: medium;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eFemale\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.05pt;border: medium;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e2.384\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133.55pt;border: medium;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.513-11.081\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: medium;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.268\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155.7pt;border: medium;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eBMI\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.05pt;border: medium;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.063\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133.55pt;border: medium;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.919-1.229\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: medium;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.411\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155.7pt;border: medium;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eHistory of corticosteroid use\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.05pt;border: medium;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.622\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133.55pt;border: medium;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.141-2.738\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: medium;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.530\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155.7pt;border: medium;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eHistory of biologic agent use\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.05pt;border: medium;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.594\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133.55pt;border: medium;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.477-5.332\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: medium;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.449\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155.7pt;border: medium;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eAnti-osteoporotic agent use\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.05pt;border: medium;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e4.624\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133.55pt;border: medium;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.743-28.764\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: medium;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.101\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155.7pt;border: medium;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eDAS28-CRP\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.05pt;border: medium;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.816\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133.55pt;border: medium;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.023-3.224\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: medium;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.042\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155.7pt;border-width: medium medium 1pt;border-style: none none solid;border-color: currentcolor currentcolor windowtext;border-image: none;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eBMD (T-score at femoral neck)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58.05pt;border-width: medium medium 1pt;border-style: none none solid;border-color: currentcolor currentcolor windowtext;border-image: none;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.358\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133.55pt;border-width: medium medium 1pt;border-style: none none solid;border-color: currentcolor currentcolor windowtext;border-image: none;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.161-0.794\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border-width: medium medium 1pt;border-style: none none solid;border-color: currentcolor currentcolor windowtext;border-image: none;padding: 0in 5.4pt;height: 0.25in;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.011\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eBMD, bone mineral density; BMI, body mass index; DAS28, disease activity score for 28 joints based on C-reactive protein; OR, Odds ratio; 95% CI, 95% confidence interval; RA, rheumatoid arthritis.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cbr\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eTable 4.\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eOrdinal logistic regression model of factors associated with the number of vertebral fractures in RA patients\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"border: none;width:432.35pt;border-collapse:collapse;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:154.0pt;border:none;border-top:solid windowtext 1.0pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width:65.75pt;border:none;border-top:solid windowtext 1.0pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eOR\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:127.55pt;border:none;border-top:solid windowtext 1.0pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e95% CI\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.05pt;border:none;border-top:solid windowtext 1.0pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cem\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003ep\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003evalue\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:154.0pt;border:none;border-top:solid windowtext 1.0pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eAge\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:65.75pt;border:none;border-top:solid windowtext 1.0pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.017\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:127.55pt;border:none;border-top:solid windowtext 1.0pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.962-1.076\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.05pt;border:none;border-top:solid windowtext 1.0pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.550\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:154.0pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eFemale\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:65.75pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e2.404\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:127.55pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.529-10.920\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.05pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.256\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:154.0pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eBMI\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:65.75pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.023\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:127.55pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.896-1.168\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.05pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.734\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:154.0pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eHistory of corticosteroid use\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:65.75pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.706\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:127.55pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.175-2.855\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.05pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.625\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:154.0pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eHistory of biologic agent use\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:65.75pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.566\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:127.55pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.518-4.733\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.05pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.427\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:154.0pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eAnti-osteoporotic agent use\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:65.75pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e4.652\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:127.55pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.735-29.460\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.05pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.103\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:154.0pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eDAS28-CRP\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:65.75pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.766\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:127.55pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e1.039-3.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.05pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.036\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:154.0pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eBMD (T-score at femoral neck)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:65.75pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.512\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:127.55pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.263-0.994\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:85.05pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 4.95pt 0in 4.95pt;height:14.25pt;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e0.048\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Yu Mincho\",serif;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eBMD, bone mineral density; BMI, body mass index; 95% CI, 95% confidence interval; DAS28-CRP,\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003edisease activity score for 28 joints based on C-reactive protein;\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eOR, Odds ratio; RA, rheumatoid arthritis.\u003c/span\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere has been no significant financial support for this work that could have influenced its outcome. The authors acknowledge the financial support provided by a UCB Japan Grant (UCBJ Grant) for the English proofreading and article processing charge of the journal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHS and KO made substantial contributions to the design of the study, acquisition, analysis, interpretation of data and writing of the manuscript. YI participated in the design of the study, acquiring data, helped to draft the manuscript and contributed to revising the manuscript critically. AH, ET, TM, SI and KI participated in acquiring data and critically contributing to revising the manuscript. TS, TK and YY contributed to revising the manuscript critically. HC critically contributed to revising the manuscript enhancing its intellectual content and approving the final content of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the institutional review board of the Gunma University Hospital. Patients provided written informed consent before taking part in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest in association with the present study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"anti-osteoporotic agent, disease activity, osteoporosis, rheumatoid arthritis, vertebral fracture","lastPublishedDoi":"10.21203/rs.3.rs-942051/v2","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-942051/v2","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntroduction: It is important to assess the risk of vertebral fractures (VFs) in patients with rheumatoid arthritis (RA), as RA is associated with a high risk of VFs. However, the epidemiology and risk of VFs in patients with RA remain inconclusive. The present study therefore clarified the prevalence and associated factors of VFs in patients with RA.\u003c/p\u003e\n\u003cp\u003eMethods: We included 107 patients (19 men and 88 women) and retrospectively investigated the number and location of VFs, bone mineral density (BMD), RA disease activity score for 28 joints based on C-reactive protein (DAS28-CRP), and history of medication for RA and osteoporosis. Based on the investigated items, we assessed the prevalence of VFs in patients with RA and the association between the clinical parameters of RA patients and VFs.\u003c/p\u003e\n\u003cp\u003eResults: The average age, disease duration, and DAS28-CRP were 67.9 years old, 14.9 years, and 2.2, respectively. We found that the prevalence of VFs in patients with RA was 30.8%, and 84.8% of patients with VFs and 62.2% of those without VFs had been treated for osteoporosis. We further found that the prevalence of VFs in patients with RA with a history of anti-osteoporotic agent use was 37.8%. In univariate analyses, patients with RA with VFs had significantly higher DAS28-CRP values, a higher rate of corticosteroid use, and lower BMD (p = 0.018, p = 0.004, and p \u0026lt; 0.001, respectively) than those without VFs. A logistic regression analysis and ordinal logistic analysis revealed that the DAS28-CRP and BMD were independent factors associated with the presence (p = 0.042 and p = 0.011, respectively) and number (p = 0.036 and p = 0.048, respectively) of VFs.\u003c/p\u003e\n\u003cp\u003eConclusions: The prevalence of VFs was relatively high in patients with RA, regardless of the use of anti-osteoporotic agents. A high disease activity score and low BMD are associated with the presence and number of VFs in patients with RA. Based on these findings, to reduce VFs in RA patients, it is important to tightly control the disease activity of RA and aggressively treat osteoporosis.\u003c/p\u003e","manuscriptTitle":"High disease activity influences the presence of vertebral fractures in rheumatoid arthritis","msid":"","msnumber":"","nonDraftVersions":[{"code":2,"date":"2024-01-08 03:45:19","doi":"10.21203/rs.3.rs-942051/v2","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2021-10-26 15:50:26","doi":"10.21203/rs.3.rs-942051/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"efc90748-1aab-475b-bd48-93f8196d6168","owner":[],"postedDate":"January 8th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":27998313,"name":"Rheumatology"}],"tags":[],"updatedAt":"2021-10-26T15:50:28+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-08 03:45:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v2","identity":"rs-942051","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-942051","identity":"rs-942051","version":["v2"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}