Bone mineral density in patients with recently diagnosed, active rheumatoid arthritis

M Güler-Yüksel ^1*, J Bijsterbosch ¹, Y PM Goekoop-Ruiterman ¹, J K de Vries-Bouwstra ², H K Ronday ³, A J Peeters ⁴, J M de Jonge-Bok ⁵, F C Breedveld ¹, B AC Dijkmans ², C F Allaart ¹ and W F Lems ²

¹ Leiden University Medical Center, Netherlands
² VU Medical Center, Netherlands
³ Haga hospital, Netherlands
⁴ Reinier de Graaf Gasthuis, Netherlands
⁵ Groene Hart hospital, Netherlands

^* To whom correspondence should be addressed. E-mail: m.yuksel{at}lumc.nl.

Accepted 14 April 2007

Abstract

Objectives: Osteoporosis is a well known extra-articular phenomenon in patients with uncontrolled, longstanding rheumatoid arthritis (RA). In the present study, the extent of osteoporosis and reduced bone mineral density (BMD) and the disease-related and demographic factors that are associated with osteoporosis and reduced BMD are examined in patients with recently diagnosed, active RA.

Methods: BMD of the total hip and the lumbar spine was measured in 381 DMARD and corticosteroid-naïve patients with recently diagnosed, active RA using dual energy x-ray absorptiometry. Osteoporosis was defined as T-score -2.5 SD and reduced BMD as Z-score -1 SD. Multivariate logistic regression analyses were performed to detect associations of osteoporosis and reduced BMD with disease activity, functional disability and joint damage (Sharp/vanderHeijde Score), as well as with demographic factors.

Results: Osteoporosis and reduced BMD were found in 11% and 25%, respectively, of the patients in the spine and/or the hip. Longer symptom duration and presence of rheumatoid factor (RF) were the only RA-specific markers for osteoporosis and reduced BMD. Further, postmenopausal status in females, a low BMI and familial osteoporosis and, remarkably, male gender were independently associated with osteoporosis and reduced BMD.

Conclusion: In DMARD and corticosteroid-naïve patients with recently diagnosed active RA, BMD seems to be well preserved and predominantly related to demographic factors. Longer symptom duration and a positive RF, but not higher disease activity or more joint damage, were related to osteoporosis and reduced BMD.

Keywords: bone mineral density, early rheumatoid arthritis, osteoporosis

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