Background Osteoporosis is a well-known extra-articular manifestation of rheumatoid arthritis (RA) and almost 2 times higher prevalence of osteoporosis was reported in female patients with RA than in healthy subjects. Accordingly, patients with RA are at increased risk of fragility fractures that lead to significant morbidity and mortality and higher healthcare cost. However, most previous epidemiologic studies regarding osteoporosis in RA have focused on female subjects, and little attention has been given to male patients with RA.
Objectives To compare the prevalence of osteoporosis between male patients with RA and healthy subjects and to identify the risk factors of osteoporosis in male patients with RA.
Methods By using a cross-sectional design, we recruited 76 male patients with RA aged 50 years and over and 76 sex-matched and age-matched healthy subjects at a university-affiliated rheumatology centre in South Korea from August 2014 to August 2016. We measured bone mineral density (BMD) at L1–4 levels of the lumbar spine and the hip (femoral neck and total hip) in all the subjects by using dual-energy X-ray absorptiometry (DEXA). We assessed the prevalence of osteoporosis defined as a T-score of ≤-2.5 according to the WHO criteria. We also investigated potential risk factors of decreased BMD and the presence of osteoporosis in male patients with RA using linear and logistic regression analyses, respectively.
Results The mean age and body mass index (BMI) of the male patients with RA were 64.5 years and 22 kg/m2, respectively, which were comparable with those of the healthy controls. The overall prevalence of osteoporosis at either the spine or the hip in the male patients with RA was significantly higher than that of the healthy controls (22.4% vs 10.5%, respectively; p=0.049). However, no significant differences in the prevalence of osteoporosis at the spine (19.7% vs 10.5%, respectively; p=0.113) and the hip (3.9% vs 0%, respectively; p=0.245) were found between the patients with RA and the controls. For the male patients with RA, the median disease duration was 37 months, the mean 28-joint Disease Activity Score using erythrocyte sedimentation rate (DAS28-ESR) was 3.28 and the median modified total Sharp score was 6. An increased titre of anti-cyclic citrullinated antibody showed a trend toward lower L1–4 BMD (β=-0.0007, p=0.057) in the multivariable linear regression analysis. In addition, DAS28-ESR of >3.2 was independently associated with the presence of osteoporosis (OR=3.85, 95% CI=1.13–13.17, p=0.032) after adjusting for confounding factors. The patients with RA whose BMIs were ≤22 kg/m2 had a higher risk of osteoporosis (OR=3.43, 95% CI=1.04 -11.33, p=0.043).
Conclusions Similar to their female counterparts, the frequency of osteoporosis in male patients with RA had an osteoporosis prevalence of about 2.1 times higher than that of the healthy subjects. Increased DAS28-ESR was an independent risk factor of osteoporosis. Our data suggest that appropriate management for osteoporosis in patients with RA is crucial not only for postmenopausal women, but also for men aged 50 years and over.
Disclosure of Interest None declared