Objectives Osteoporosis is a well known complication of rheumatoid arthritis (RA). Both osteoporosis and RA are diseases predominantly affecting women. The aim of this study was to investigate the bone mineral density (BMD) in Scandinavian males with RA and to analyse the impact of different disease dependent and disease independent variables on bone health.
Methods Bone mineral measurements were done in 103 male RA patients attending a referral clinic of rheumatology. The BMD values were correlated with rheumatoid factor (RF), duration of disease, presence of erosions, degree of inflammation (DAS28), functional capacity (HAQ), treatment, levels of biologically active testosterone, body mass index (BMI) and smoking.
Results The patients were 20–70 years old with a median disease duration of 4 years (range 0–43). They had small but significant reductions in their BMD compared with an age and gender matched reference population (z scores). The mean BMD was lowered 6%(p < 0,01) in femoral neck, 6%(p < 0,01) in the trochanteric region, 7%(p < 0,01) in the region of Ward, and 4%(p < 0.05) in the spine. However, a substantial proportion of the patients had reduced bone mass defined as BMD lower than -1SD(z score). Thus 45/98 had reduced bone mass in femoral neck and 47/102 in the spine which is far more than the expected 16%.
Z-scores at Wards triangle correlated with disease duration and presence of erosions. At trochanter z-scores correlated with duration of disease, erosions, HAQ, as well as BMI. The best multiple regression analysis with HAQ, erosions and BMI explained 22% of the variance. At femoral neck z-scores did not correlate to any of the tested variables. At spine (L2-L4) only erosions were significant correlated with z-scores.
Sulphasalazine had a statistically significant positive correlation to the bone in Ward´s triangle and trochanter while methotrexate had a negative correlation to the bone in the trochanter region.
Neither in correlation analysis nor in multiple regression analysis there were any correlations between z-scores at hip or spine and RF, current degree of inflammation, treatment with glucocorticoids, parenteral gold or ciclosporin, levels of biologically active testosteron or smoking in any of the skeletal sites measured.
Conclusion A substantial proportion of males with RA had reduced bone mass. Variables that reflect structural damage had large impact on bone mineral density.
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