Associations between SARC-F score and FRAX score in patients with rheumatoid arthritis: A cross-sectional study.

INTRODUCTION

Rheumatoid arthritis (RA) increases the risk of osteoporotic fractures due to chronic inflammation, glucocorticoid use, and reduced muscle mass. Sarcopenia, frequently underdiagnosed in RA, may contribute independently to skeletal fragility. This study aimed to determine the associations between sarcopenia risk, by the SARC-F screening tool, and 10-year fracture probability, calculated via FRAX, in patients with RA.

MATERIALS AND

METHODS

A cross-sectional, retrospective study was conducted among 66 patients with RA aged ≥ 40 years in Mexico. Sarcopenia risk was assessed using the SARC-F questionnaire. Muscle mass was measured via dual-energy X-ray absorptiometry (DXA), and sarcopenia was defined according to EWGSOP2 criteria. Fracture risk was calculated using the Mexican FRAX tool. Four fracture risk scores were calculated: major osteoporotic and hip fracture risk, each assessed with and without bone mineral density (BMD).

RESULTS

Sixty percent of participants were at high risk of sarcopenia (SARC-F ≥ 4), and 33.3% met EWGSOP2 sarcopenia criteria. SARC-F scores correlated negatively with femoral neck T-scores (r = -0.306, p = 0.013) and muscle mass (r = -0.390, p = 0.001). Significant weak-to-moderate positive correlations were observed between SARC-F and FRAX-predicted fracture risk (MOF-FRAX: r = 0.354 and 0.310; HF-FRAX: r = 0.294 and 0.267; all p < 0.05). SARC-F scores were significantly higher in patients classified as high fracture risk (p = 0.035).

CONCLUSION

Sarcopenia risk, as measured by SARC-F, is significantly associated with increased FRAX-estimated fracture risk in RA patients. Incorporating SARC-F into routine assessments may improve early identification of patients at high fracture risk. Key Points • Sarcopenia is common in rheumatoid arthritis and is frequently under-detected. • Higher sarcopenia risk is associated with poorer bone health and increased fracture probability. • Simple screening tools, such as SARC-F, may help identify RA patients at elevated fracture risk earlier in clinical practice.