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Extended report
Accelerated metacarpal bone mineral density loss is associated with radiographic progressive hand osteoarthritis
  1. M Güler-Yüksel1,
  2. J Bijsterbosch1,
  3. C F Allaart1,
  4. I Meulenbelt2,
  5. H M Kroon3,
  6. I Watt3,
  7. W F Lems4,5,
  8. M Kloppenburg1
  1. 1Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2Department of Molecular Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
  3. 3Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
  4. 4Department of Rheumatology, VU Medical Center, Amsterdam, The Netherlands
  5. 5Department of Rheumatology, Jan van Breemen Institute, Amsterdam, The Netherlands
  1. Correspondence to M Güler-Yüksel, Department of Rheumatology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands; m.yuksel{at}


Objective To study the association between metacarpal bone mineral density (BMD) loss and progressive hand osteoarthritis (OA) over 2 years.

Methods Using the Kellgren–Lawrence (KL) grading scale and the Osteoarthritis Research Society International Atlas, standardised hand radiographs of 181 patients with primary OA at multiple sites (mean age 60 years, 80% women, mean body mass index 27 kg/m2) were assessed for hand OA at baseline (KL ≥ 2 in two or more hand joints) and progressive hand OA over 2 years (≥ 1 point increase in total osteophyte and joint space narrowing score in patients with hand OA at baseline). Changes in BMD were measured over 2 years in metacarpals 2–4 by digital x-ray radiogrammetry. Accelerated BMD loss was defined as loss of >3 mg/cm2/year. Logistic regression analyses were performed to assess the associations between BMD loss and progressive hand OA.

Results The baseline prevalence of hand OA was 68% and, after 2 years, 32% of these patients had progressive hand OA. Accelerated BMD loss was present in 79% of the patients with progressive hand OA compared with 60% and 57% of the patients with non-progressive hand OA and no hand OA, respectively. BMD loss was independently associated with progressive hand OA compared with non-progressive hand OA with a RR (95% CI) of 2.1 (1.1 to 4.3).

Conclusion Accelerated metacarpal BMD loss is associated with progressive hand OA over a period of 2 years; knowledge of common mechanisms may lead to development of therapeutic interventions for hand OA.

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  • Funding The GARP study was funded by Pfizer Inc, Groton, Connecticut, USA. The authors, not the sponsors, were responsible for the study design, the collection, analyses and interpretation of data, the writing of this article and the decision to publish.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the medical ethics committee of Leiden University Medical Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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