The relationship between focal erosions and generalized osteoporosis in postmenopausal women with rheumatoid arthritis
Department of Medicine, Division of Rheumatology
Medical Subject Headings
Aged; Antirheumatic Agents; Arthritis, Rheumatoid; Bone Density; Bone Diseases; Cohort Studies; Female; Fractures, Bone; Hand; Health Surveys; Hip Joint; Humans; Linear Models; Longitudinal Studies; Middle Aged; Multivariate Analysis; Osteoporosis, Postmenopausal; Risk Factors; Severity of Illness Index; Spine; Treatment Outcome
Musculoskeletal Diseases | Rheumatology | Skin and Connective Tissue Diseases | Women's Health
OBJECTIVE: Among rheumatoid arthritis (RA) patients who have had the disease for 10 years, more than half have focal erosions, and the risk of fracture is doubled. However, there is little information about the potential relationship between focal erosions and bone mineral density (BMD). The aim of this study was to determine whether lower BMD is associated with higher erosion scores among patients with RA.
METHODS: We enrolled 163 postmenopausal women with RA, none of whom were taking osteoporosis medications. Patients underwent dual x-ray absorptiometry at the hip and spine and hand radiography, and completed a questionnaire. The hand radiographs were scored using the Sharp method, and the relationship between BMD and erosions was measured using Spearman's correlation coefficients and adjusted linear regression models.
RESULTS: Patients had an average disease duration of 13.7 years, and almost all were taking a disease-modifying antirheumatic drug. Sixty-three percent were rheumatoid factor (RF) positive. The median modified Health Assessment Questionnaire score was 0.7, and the average Disease Activity Score in 28 joints was 3.8. The erosion score was significantly correlated with total hip BMD (r = -0.33, P < 0.0001), but not with lumbar spine BMD (r = -0.09, P = 0.27). Hip BMD was significantly lower in RF-positive patients versus RF-negative patients (P = 0.02). In multivariable models that included age, body mass index, and cumulative oral glucocorticoid dose, neither total hip BMD nor lumbar spine BMD was significantly associated with focal erosions.
CONCLUSION: Our results suggest that hip BMD is associated with focal erosions among postmenopausal women with RA, but that this association disappears after multivariable adjustment. While BMD and erosions may be correlated with bone manifestations of RA, their relationship is complex and influenced by other disease-related factors.
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Citation: Arthritis Rheum. 2009 Jun;60(6):1624-31. doi: 10.1002/art.24551. Link to article on publisher's site
Solomon, Daniel H.; Finkelstein, Joel S.; Shadick, Nancy; LeBoff, Meryl S.; Winalski, Carl S.; Stedman, Margaret; Glass, Roberta; Brookhart, M Alan.; Weinblatt, Michael E.; and Gravallese, Ellen M., "The relationship between focal erosions and generalized osteoporosis in postmenopausal women with rheumatoid arthritis" (2009). Rheumatology Publications and Presentations. 44.