Background Osteoporosis is a well known extra-articular manifestation of the inflammatory disease process in rheumatoid arthritis (RA), causing increased fracture risk. Potent anti-inflammatory treatment blocking e.g. TNF-alpha has been shown to reduce the rate of generalized bone loss . Several short term studies have illuminated our understanding on bone loss in RA; however in general there is a lack of long term follow-up studies exploring bone density changes in a long term perspective.
Objectives To study long term changes in bone density at hip and spine in patients with early RA in the biologic treatment era.
Methods Between 1999 and 2001 a total of 93 RA patients fulfilling the ACR RA criteria (disease duration < 1 yr) were prospectively included in a long term observational study. According to protocol a broad specter of demographic and clinical data was collected. Bone mineral density (BMD) measurements at lumbar spine and hip (femoral neck and total hip) were performed by trained nurses using the same dual energy x-ray absorptiometry (DXA) equipment Lunar Prodigy (General Electric) at baseline and after 2, 5 and 10 yrs. The machine was stable during the whole period.
Results Patient characteristics at baseline: mean (SD) age 50.4 (13.6) yrs, females 61.7%, RF+ 62.8%, CCP+ 60.6% and erosive 2.1%. Baseline disease characteristics: swollen-28 joints 8.4, tender-28 joints 9.7, MHAQ 0.68, ESR 29.2 mm/hr and CRP 28.9 mg/dl. Ever use of prednisolone 73.4%, synthetic DMARDs 93.6% and biologic DMARDs 53.2%. Rate of bone loss at 2, 5 and 10 years is shown in the table. At femoral neck and total hip bone loss was linear with average annual bone loss of 0.64% at femoral neck and 0.49% at total hip.
Conclusions Our data suggest that aggressive anti inflammatory treatment protects against bone loss at spine whereas bone loss continues at the hip. However interestingly the rate of bone loss observed in our study at hip and spine is at the same rate as reported in the general population [2, 3].
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Warming L et al. Osteoporos Int 2002;13:105-12.
Disclosure of Interest None Declared