Extended report
Data driven attempt to create a clinical algorithm for
identification of women with rheumatoid arthritis at high risk of
osteoporosis
Tore K Kviena, Glenn Haugeberga, Till Uhliga, Jan A Falchb, Johan I Halsec, Willem F Lemsd, Ben A C Dijkmansd, Anthony D Woolfe
a Oslo City Department
of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway, b Department
of Internal Medicine, Aker Hospital, Oslo, Norway, c Osteoporosis Clinic, Oslo, Norway, d Department
of Rheumatology, Free University Hospital, Amsterdam, Netherlands, e Royal
Cornwall Hospital, Truro, UK
Correspondence to: Professor T K Kvien, Department of Rheumatology, Diakonhjemmet Hospital, Box 23 Vinderen, N-0319 Oslo, Norway Email: t.k.kvien{at}ioks.uio.no
Accepted for publication 15 March 2000
OBJECTIVES
To examine
relations between osteoporosis and low bone mass and demographic and
clinical variables in patients with rheumatoid arthritis (RA), in an
attempt to develop a data driven clinical tool for identification of
patients at high risk of osteoporosis.
METHODSAll patients
were recruited from a county based register and were examined cross
sectionally with a variety of clinical and health status measures as
well as bone density measures (anteroposterior spine L2-4, total hip,
and femoral neck). Associations between osteoporosis (T score
2.5SD) and low bone mass (T score 1SD), on the one hand,
and demographic and clinical measures, on the other, were examined
bivariately and by logistic regression analyses.
RESULTS394 patients
with a mean age of 54.8 years were examined. The percentages having
osteoporosis/low bone mass were 16.8/45.8, 14.7/54.5 and 14.7/55.5 in
spine L2-4, total hip, and femoral neck, respectively. Osteoporosis and
low bone mass were bivariately related to age, body mass index (BMI),
disease duration, disease process measures, presence of deformed
joints, physical disability, current use of corticosteroids, and
history of non-vertebral fracture. In multivariate analyses, age >60
years, low BMI, and current use of corticosteroids were consistently
related to osteoporosis and to low bone mass at all sites. The presence
of deformed joints was associated with osteoporosis at the total
hip, and a history of previous non-vertebral fracture with
osteoporosis at the femoral neck. The Modified Health Assessment
Questionnaire (MHAQ) 
1.5 and non-vertebral fracture were also
independently associated with low bone mass at the hip. The logistic
regression analyses models could, however, only predict osteoporosis
with a sensitivity of about 50-60% and a specificity of 80-90% at
the various measurement sites, and low bone mass with a sensitivity and
specificity of about 70%.
CONCLUSIONConsideration
of demographic and disease markers may be of some help in predicting
presence of osteoporosis or low bone mass, but a combination of markers
cannot be used as a clinical tool with sufficient sensitivity and
specificity for the identification of osteoporosis or low bone mass
in patients with RA.
© 2000 by Annals of the Rheumatic Diseases
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