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Bone mineral density in patients with recently diagnosed, active rheumatoid arthritis
  1. M Güler-Yüksel1,
  2. J Bijsterbosch1,
  3. Y P M Goekoop-Ruiterman1,
  4. F C Breedveld1,
  5. C F Allaart1,
  6. J K de Vries-Bouwstra2,
  7. B A C Dijkmans2,7,
  8. W F Lems2,7,
  9. H K Ronday3,
  10. A J Peeters4,
  11. J M de Jonge-Bok5
  1. 1
    Leiden University Medical Center, Leiden, The Netherlands
  2. 2
    VU Medical Center, Amsterdam, The Netherlands
  3. 3
    Haga Hospital, The Hague, The Netherlands
  4. 4
    Reinier de Graaf Gasthuis, Delft, The Netherlands
  5. 5
    Groene Hart Hospital, Gouda, The Netherlands
  6. 7
    Jan van Breemen Institute, Amsterdam, The Netherlands
  1. M Güler-Yüksel, MD, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, The Netherlands; m.yuksel{at}lumc.nl

Abstract

Objectives: Osteoporosis is a well-known extra-articular phenomenon in patients with uncontrolled, long-standing 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 were examined in patients with recently diagnosed, active RA.

Methods: BMD of the total hip and the lumbar spine was measured using dual-energy x ray absorptiometry in 381 patients with recently diagnosed active RA, who had never been treated with DMARDs or corticosteroids. Osteoporosis was defined as a 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, joint damage (Sharp–van der Heijde score) and demographic factors.

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

Conclusion: In patients with recently diagnosed active RA who had never been treated with DMARDs or corticosteroids, 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.

  • early rheumatoid arthritis
  • bone mineral density
  • osteoporosis

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Footnotes

  • Competing interests: Professor Dr F C Breedveld was paid for expert testimony for Centocor in 1996 and was a paid speaker in a Schering-Plough-sponsored symposium. Dr C F Allaart was a paid speaker in a Schering-Plough-sponsored symposium in 2006.

  • The BeSt trial was supported by a grant of the Dutch College for Health Insurance Companies (CVZ). Schering-Plough and Centocor provided additional funding. The funding sources were not involved in the design of the study, the collection, analysis and interpretation of the data, the writing of the report, or the decision to submit the paper for publication.

  • Abbreviations:
    BeSt
    Behandel Strategieen
    BMD
    bone mineral density
    BMI
    body mass index
    CRP
    C-reactive protein
    DAS
    Disease Activity Score
    DMARD
    disease-modifying antirheumatic drug
    HAQ
    Health Assessment Questionnaire
    HRT
    hormone replacement therapy
    RA
    rheumatoid arthritis
    RANKL
    receptor activator of nuclear factor kappa B ligand
    RF
    rheumatoid factor

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