The effect of low-dose methotrexate on bone mineral density in patients with early rheumatoid arthritis

Taşçıoğlu, Funda; Oner, Cengiz; Armağan, Onur

doi:10.1007/s00296-003-0298-z

Cited by 19 publications

(14 citation statements)

References 27 publications

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“…Femoral neck BMAD values, however, were significantly lower in patients with systemic JRA. The smaller and less mineralized skeletons observed in our polyarticular JRA cohort are consistent with findings in previous studies (15)(16)(17).…”

Section: Discussionsupporting

confidence: 93%

“…Methotrexate (MTX), a disease-modifying antirheumatic drug, is currently pre-scribed to an estimated 25,000 children in the US, or 39% of patients with JRA (13). Low-dose MTX therapy has been reported to have a sparing effect on wholebody and lumbar spine (L-spine) BMC when used instead of or in addition to systemic glucocorticoids (14)(15)(16)(17). In children also treated with glucocorticoids, a slower rate of bone mineral acquisition has been observed.…”

mentioning

confidence: 99%

“…The majority of studies that have evaluated bone mass in patients with JRA have used dual x-ray absorptiometry (DXA) (5,7,8,10,11,17). Although DXA is a practical and common tool for the assessment of bone health, the application of DXA to pediatric populations has several limitations.…”

mentioning

confidence: 99%

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Musculoskeletal abnormalities of the tibia in juvenile rheumatoid arthritis

Felin¹,

Prahalad²,

Askew³

et al. 2007

Arthritis & Rheumatism

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Objective. To characterize local bone geometry, density, and strength, using peripheral quantitative computed tomography (pQCT), compared with general bone characteristics as measured using dual x-ray absorptiometry (DXA), and to assess their relationship to disease-related factors in children with juvenile rheumatoid arthritis (JRA).Methods. Forty-eight children ages 4-18 years with JRA (17 pauciarticular, 23 polyarticular, 8 systemic) were compared with age-matched healthy controls (n ‫؍‬ 266). Measurements included cortical and trabecular bone geometry, density, and strength at the distal and midshaft tibia determined by pQCT, and whole-body, lumbar spine, and femoral neck measurements by DXA.Results. Methotrexate (MTX) was prescribed to 23 of 48 patients (47.9%) and glucocorticoids and MTX were prescribed to 15 of 48 patients (31.3%), with the greatest use in children with systemic JRA. All JRA patients had decreased tibia trabecular bone density, cortical bone size and strength, and muscle mass. Children with systemic JRA had lower femoral neck densities. Systemic JRA was associated with a shorter, less mineralized skeleton, while a narrower, less mineralized skeleton was observed in polyarticular JRA. The tibia diaphysis was narrower with decreased muscle mass, but normal, size-adjusted bone mineral in all subtypes indicated a localized effect of JRA on bone. Patients exposed to glucocorticoids and MTX or to glucocorticoids or MTX alone had greatly reduced trabecular density, cortical bone geometry properties, and bone mineral content, muscle mass, and bone strength.Conclusion. Children with JRA have decreased skeletal size, muscle mass, trabecular bone density, cortical bone geometry, and strength. Not surprisingly, these bone abnormalities are more pronounced in children with greater disease severity.

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Section: Discussionsupporting

confidence: 93%

mentioning

confidence: 99%

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Musculoskeletal abnormalities of the tibia in juvenile rheumatoid arthritis

Felin¹,

Prahalad²,

Askew³

et al. 2007

Arthritis & Rheumatism

View full text Add to dashboard Cite

show abstract

“…Low dose oral methotrexate used in rheumatoid arthritis has not shown any effect on BMD [77][78][79][80][81][82]. However, the doses in these studies were on average 7.5-11 mg methotrexate orally or i.v.…”

Section: Methotrexatementioning

confidence: 99%

“…Sulphasalazine did not seem to have a major negative effect on BMD in patients with rheumatoid arthritis [157]. One study actually pointed at a high trochanteric BMD in patients receiving sulphasalazine [158].…”

Section: Disease Modifying Antirheumatic Drugs (Dmard)mentioning

confidence: 99%

Adverse Effects of Drugs on Bone and Calcium Metabolism/Physiology

Vestergaard

2007

Clinic Rev Bone Miner Metab

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Drugs may affect bone turnover and density in many ways. However, the disease for which the drugs are administered may also contribute to bone loss. Infection with human immunodeficiency virus leads to a loss of bone mineral, while treatment with highly active antiretroviral therapy does not seem to contribute to further bone loss. Type 1 diabetes is associated with a decrease in bone mineral, while type 2 diabetes is associated with an increase. The new class of thiazolidinediones (glitazones) has been associated with an increased loss of bone mineral. In breast cancer treatment, tamoxifen is associated with an increased bone mineral, while the newer class of aromatase inhibitors through a decrease in serum oestradiol are associated with an increased loss of bone mineral. Strong analgesics (opioids) may decrease bone mineral density through inhibition of gonadotrophins while weak analgesics such as the non-steroidal anti-inflammatory drugs may increase bone mineral through an effect on the prostaglandin system. However, possibly through an increased risk of falls, the weak analgesics are associated with an increased risk of fractures. Proton pump inhibitors may lead to a decreased calcium absorption and thus a decreased bone mineral and an increased risk of fractures.

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Vertebral strength changes in rheumatoid arthritis patients treated with alendronate, as assessed by finite element analysis of clinical computed tomography scans: A prospective randomized clinical trial

Mawatari

Miura

Hamai

et al. 2008

Arthritis & Rheumatism

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Objective. Finite element analysis of clinical computed tomography (CT) scans provides a noninvasive means of assessing vertebral strength that is superior to dual x-ray absorptiometry (DXA)-measured areal bone mineral density. The present study was undertaken to compare strength changes, measured using this newer method, in rheumatoid arthritis (RA) patients who were treated with alendronate (ALN) versus those who were not.Methods. Thirty female RA patients without radiologic signs of L3 compression fractures or a history of osteoporosis medication were enrolled in a prospective randomized clinical trial. Patients were randomly assigned to the ALN group (5 mg orally, once daily) or the control group not receiving antiresorptive treatment. All patients were evaluated by DXA and quantitative CT at baseline and reevaluated after a mean of 12.2 months. Nonlinear finite element analysis was performed on the CT scans (n ‫؍‬ 29 available for analysis) to compute an estimate of vertebral compressive strength and to assess strength changes associated with changes in the trabecular compartment and the outer 2 mm of bone (peripheral compartment).Results. On average, vertebral strength was significantly decreased from baseline in the control group (n ‫؍‬ 15) (median change ؊10.6%; P ‫؍‬ 0.008) but was maintained in the ALN group (n ‫؍‬ 14) (median change ؉0.4%; P ‫؍‬ 0.55), with a significant difference between the 2 groups (P < 0.01). Strength decreased more rapidly within the trabecular bone, and ALN treatment was much more effective in the peripheral than the trabecular compartment.Conclusion. Our results indicate that patients with RA can lose a substantial amount of vertebral strength over a relatively short period of time, and this loss can be prevented by ALN, primarily via its positive effect on the outer 2 mm of vertebral bone.Osteoporosis occurs more frequently in patients with rheumatoid arthritis (RA) than in otherwise healthy individuals (1). The most serious complications of osteoporosis are vertebral and nonvertebral fractures. Although the pathogenesis of RA-associated osteoporosis is not fully understood, multiple factors are known to be involved, including persistent inflammation ISRCTN: 95526224.

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The effect of low-dose methotrexate on bone mineral density in patients with early rheumatoid arthritis

Abstract: Our findings suggest that low-dose methotrexate has no negative effect on BMD in premenopausal RA patients.

Cited by 19 publications

References 27 publications

Musculoskeletal abnormalities of the tibia in juvenile rheumatoid arthritis

Musculoskeletal abnormalities of the tibia in juvenile rheumatoid arthritis

Adverse Effects of Drugs on Bone and Calcium Metabolism/Physiology

Vertebral strength changes in rheumatoid arthritis patients treated with alendronate, as assessed by finite element analysis of clinical computed tomography scans: A prospective randomized clinical trial

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