Determinants of axial bone loss in rheumatoid arthritis

Abstract

To assess mechanisms that cause generalized osteoporosis in rheumatoid arthritis (RA), we measured bone mineral density (BMD) by dual photon absorptiometry in the lumbar spine and femoral neck of 111 patients with RA. BMD was significantly reduced at both sites in these patients. Physical activity correlated significantly with BMD in patients with RA, and was found, by multiple regression analysis, to be a significant predictor of femoral bone density in female patients. Multiparity exerted a protective effect on lumbar bone density. Prednisolone (mean dosage 8 mg/day) was not associated with significantly increased bone loss in women, whereas higher dosages in men (mean 10.3 mg/day) were associated with increased lumbar bone loss. Reduced physical activity leading to a form of disuse osteoporosis appears to be an important factor in axial bone loss in RA.

Rheumatoid arthritis, corticosteroid therapy and hip fracture.

“…The release of cytokines by inflamed synovium mediates juxta-articular osteopenia which is most marked in the appendicular skeleton.7 Studies of axial bone density in patients with rheumatoid arthritis are rather less consistent. 6 28 In conclusion, our data provide evidence that the risk of hip fracture is approximately doubled among patients who suffer from rheumatoid arthritis, and among those taking steroids. The risk increases attributable to each of these factors are, to some extent, independent of each other.…”

“…In the remaining 23, the major reasons for steroid use were chronic obstructive airways disease and polymyalgia rheumatica. Table 2 shows that the unadjusted risk (odds ratio) of hip fracture in patients with rheumatoid arthritis was 2-1 (95% confidence interval (CI) 1-0 to 4 7; p=006); that in subjects who were receiving steroids was [2][3][4][5][6][7] (95% CI 1-2 to 5-8; p=001). Table 2 also shows that when these risk estimates were mutually adjusted in a logistic regression model, it was apparent that the effects of rheumatoid arthritis and steroid use on hip fracture were, to a large extent, independent of each other.…”

Effects of inflammation and treatment on bone turnover and bone mass in polymyalgia rheumatica

“…We did not measure Health Assessment Questionnaire scores (40) prior to treatment, but all patients were mobile, despite stiffness, and were able to walk into the clinic, so it is unlikely that immobility exerted a major effect. Immobility is not associated with bone loss in early RA (22), but it can be a factor in established disease (41).…”

Prevention of bone mineral density loss in patients with rheumatoid arthritis treated with anti-TNFα therapy

“…The later is likely attributed to a number of factors including disease itself, reduced exercise activity, steroids therapy (Laan et al 1993;Hall et al 1993;Cortet et al 1997;Haugeberg et al 2002;Mikuls 2003), or common postmenopausal osteoporosis. Accelerated generalized bone loss is often considered as one of the major complications of RA (Westhovens and Dequeker 2000;Green and Deodhar 2001;Sambrook et al 1987;Goldring and Gravallese 2000), as patients often have an increased risk of hip (Cooper et al 1995;Huusko et al 2001;van Staa et al 2006) or vertebral fractures Peel et al 1995;van Staa et al 2006). Blockade of mediators of joint infl ammation is a promising strategy to halt or perhaps improve the severity of these bone related manifestations.…”