Vol 9, No 3 (2023)
Review paper
Published online: 2023-10-01

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The importance of bone mineral density and structure in fracture risk assessment of patients with rheumatoid arthritis and ankylosing spondylitis — perspectives

Daniel Dawid Jeka1
Rheumatology Forum 2023;9(3):145-148.


Osteoporosis is a metabolic bone disease that is associated with an increased risk of fractures. The increased risk of fractures in osteoporosis occurs both due to a decrease in bone mineral density (BMD) and bone microarchitecture impairment. Dual-energy X-ray absorptiometry (DXA) is the current gold standard in osteoporosis diagnosis. In a DXA scan, fracture risk is only assessed based on a BMD measurement. This is sufficient to estimate true fracture risk in the general population. Unfortunately, in rheumatic diseases, such as rheumatoid arthritis (RA) or ankylosing spondylitis (AS), BMD often increases. However, the incidence of fractures in RA/AS patients is higher than in the general population. Put together, it becomes obvious that a BMD measurement alone is not sufficient to estimate the risk of fractures in rheumatic diseases. The increase in fracture incidence is strongly associated with bone microarchitecture impairment, which is not evaluated in a standard DXA scan. Therefore, it is necessary to introduce other diagnostic methods. One such assessment is the trabecular bone score (TBS). TBS is a numerical method that can be used during a DXA scan. It allows for a fracture risk assessment in patients with rheumatic diseases, much more accurately than just a BMD measurement.

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