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Objective: To investigate the relationship between hand bone mineral density (BMD) and radiographic joint damage, and between hand BMD and fractures in 50-70 year old women with longstanding RA. Methods: Demographic, clinical data, and imaging data on hand radiographs and Genants vertebral deformity score on spine radiographs were collected from 135 women with RA of >5 years, recruited from three European rheumatology clinics. Metacarpal hand BMD was measured by digital hand x ray radiogrammetry (DXR), and hip and lumbar spine BMD by dual x ray absorptiometry (DXA). Multiple regression analyses were used to examine associations between hand BMD and radiographic joint damage, and hand BMD and fractures. Results: Hand BMD was strongly and independently associated with radiographic hand joint damage in a linear regression model adjusted for age, centre, BMI, disease duration, RF, 18 deformed joint count, ESR, and femoral neck BMD. In a multivariate logistic regression model adjusted for relevant variables, hand BMD and femoral neck BMD, but not spine BMD, were independently associated with vertebral deformities and with non-vertebral fractures. Conclusion: BMD measured by DXR on conventional hand radiographs in patients with RA may potentially be used as an indicator of joint damage and of vertebral and nonvertebral fracture risk. I n rheumatoid arthritis (RA) the osteoclast cell plays a major part in the development of bone erosions and osteoporosis, both periarticular and generalised. However, data are lacking on the relationship between these osteoclast cell driven features and both hand bone mass and fractures.In this cross sectional study we explored the association between hand bone mineral density (BMD) measured by digital x ray radiogrammetry (DXR), firstly, with radiographic joint damage, and secondly, with fractures (vertebral deformities and non-vertebral fractures). PATIENTS AND METHODS Study group and clinical variablesOne hundred and thirty five female patients with RA were recruited from a recently published European three centre cross sectional study examining 150 patients, aged 50-70 years, with disease duration of >5 years.1 Fifteen patients from the original cohort were excluded from the current analysis owing to technical problems in assessing hand BMD with DXR, related to severe joint damage. Demographic and clinical variables were obtained on interview and clinical examination (table 1). This data collection has previously been described in detail.1 Hand radiographs were read according to the modified Larsen method (range 0-120). Vertebral deformities were scored according to Genants semiquantitative method, which grades vertebral height reduction at T4-L4 into grade 0 (normal), 1 (20-25% reduction), 2 (25-40% reduction), and 3 (.40% height reduction). A scoring of at least grade >1 was considered a deformed vertebra.BMD measurement BMD measurements of the lumbar spine and the femoral neck were performed using dual x ray absorptiometry (DXA) as described previously.1 The DXA machines were cros...

Background: Bone mineral density (BMD) measurements are frequently performed repeatedly for each patient. Subsequent BMD measurements allow reproducibility to be assessed. Objective: To examine the reproducibility of BMD by dual energy x ray absorptiometry (DXA) and to investigate the practical value of different measures of reproducibility in a group of postmenopausal women. Methods: Ninety five women, mean age 59.9 years, underwent two subsequent BMD measurements of spine and hip. Reproducibility was expressed as smallest detectable difference (SDD), coefficient of variation (CV), and intraclass correlation coefficient (ICC). Sources of variation were investigated by multilevel analysis. Results: The median interval between measurements was 0 days (range 0-45). The mean difference (SD) between the measurements (g/cm 2 ) was 20.001 (0.02) and 20.0004 (0.02) at L1-4 and the total hip, respectively. At L1-4 and the total hip, SDD (g/cm 2 ) was ¡0.05 and ¡0.04 and CV (%) was 1.92 and 1.59, respectively. The ICC at spine and hip was 0.99. Conclusions: Reproducibility in the postmenopausal women studied was good. In a repeated DXA scan a BMD change exceeding 2!2CV (%), the least significant change (LSC), or the SDD should be regarded as significant. Use of the SDD is preferable to use of the CV and LSC (%) because of its independence from BMD and its expression in absolute units. Expressed as SDD, a BMD change of at least ¡0.05 g/cm 2 at L1-4 and ¡0.04 g/cm 2 at the total hip should be considered significant.

Objective. To examine variables associated with bone mineral density (BMD) and vertebral deformities in women with rheumatoid arthritis (RA) from 3 northwest European countries. Methods. Female patients were recruited from rheumatology clinics in Oslo, Norway; Truro, UK; and Amsterdam, The Netherlands (150 total, 50 per center, age 50 -70 years, disease duration >5 years). Demographic and clinical data were collected and BMD was measured by means of dual energy x-ray absorptiometry. Associations between demographic and clinical measures on the one hand and BMD and vertebral deformities on the other were investigated by single and multiple regression analyses. Results. Body mass index (BMI), medication use, RA damage measures, and BMD differed significantly between the 3 centers. Overall, Norwegian patients had the lowest BMI, used more corticosteroids and antiosteoporotic drugs, had lower joint damage measured by Larsen score, and lower BMD at both spine and hip. High age, low BMI, and high cumulative dose of corticosteroids (last 2 years) are related to low BMD. A high Larsen score was associated with low BMD at the hip. Larsen score was the independent determinant of vertebral deformities after correction for center, age, BMI, and BMD. Conclusion. Data from 3 countries on BMD and vertebral deformities in female patients aged 50 -70 years with longstanding RA are presented, demonstrating an association between radiographic RA damage and low BMD and between radiographic RA damage and vertebral deformities.

We observed a favourable effect of alendronate on the BMD of the lumbar spine and on the markers of bone turnover in patients with RA treated with low-dose prednisone. These data support the conclusion that the prescribing of alendronate is not only beneficial in patients treated with high-dose prednisone but also in RA patients chronically treated with low-dose prednisone.