scholarly journals P129 Predictors of low bone mineral density in rheumatoid arthritis

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Malika A Swar ◽  
Marwan Bukhari
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Bone Mineral Density ◽  
Family History ◽  
Bone Loss ◽  
Femoral Neck ◽  
Bone Mineral ◽  
Fragility Fracture ◽  
Mineral Density ◽  
History Of

Abstract Background/Aims  Osteoporosis (OP) is an extra-articular manifestation of rheumatoid arthritis (RA) that leads to increased fracture susceptibility due to a variety of reasons including immobility and cytokine driven bone loss. Bone loss in other populations has well documented risk factors. It is unknown whether bone loss in RA predominantly affects the femoral neck or the spine. This study aimed to identify independent predictors of low bone mineral density (BMD) in patients RA at the lumbar spine and the femoral neck. Methods  This was a retrospective observational cohort study using patients with Rheumatoid arthritis attending for a regional dual X-ray absorptiometry (DEXA) scan at the Royal Lancaster Infirmary between 2004 and 2014. BMD in L1-L4 in the spine and in the femoral neck were recorded. The risk factors investigated were steroid use, family history of osteoporosis, smoking, alcohol abuse, BMI, gender, previous fragility fracture, number of FRAX(tm) risk factors and age. Univariate and Multivariate regression analysis models were fitted to explore bone loss at these sites using BMD in g/cm2 as a dependant variable. . Results  1,527 patients were included in the analysis, 1,207 (79%) were female. Mean age was 64.34 years (SD11.6). mean BMI was 27.32kg/cm2 (SD 5.570) 858 (56.2%) had some steroid exposure . 169(11.1%) had family history of osteoporosis. fragility fracture history found in 406 (26.6%). 621 (40.7%) were current or ex smokers . There was a median of 3 OP risk factors (IQR 1,3) The performance of the models is shown in table one below. Different risk factors appeared to influence the BMD at different sites and the cumulative risk factors influenced BMD in the spine. None of the traditional risk factors predicted poor bone loss well in this cohort. P129 Table 1:result of the regression modelsCharacteristicB femoral neck95% CIpB spine95%CIpAge at scan-0.004-0.005,-0.003<0.01-0.0005-0.002,0.00050.292Sex-0.094-0.113,-0.075<0.01-0.101-0.129,-0.072<0.01BMI (mg/m2)0.0080.008,0.0101<0.010.01130.019,0.013<0.01Fragility fracture-0.024-0.055,0.0060.12-0.0138-0.060,0.0320.559Smoking0.007-0.022,0.0350.650.0286-0.015,0.0720.20Alcohol0.011-0.033,0.0 5560.620.0544-0.013,0.1120.11Family history of OP0.012-0.021,0.0450.470.0158-0.034,0.0650.53Number of risk factors-0.015-0.039,0.0080.21-0.039-0.075,-0.0030.03steroids0.004-0.023,0.0320.030.027-0.015,0.0690.21 Conclusion  This study has shown that predictors of low BMD in the spine and hip are different and less influential than expected in this cohort with RA . As the FRAX(tm) tool only uses the femoral neck, this might underestimate the fracture risk in this population. Further work looking at individual areas is ongoing. Disclosure  M.A. Swar: None. M. Bukhari: None.

scholarly journals AB0913 PREDICTING PATIENTS AT RISK OF FRAGILITY FRACTURE WITH NORMAL BONE MINERAL DENSITY: AN OBSERVATIONAL STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1758.1-1758
Author(s):  
C. Saleh ◽  
M. Bukhari ◽  
S. M. Bilgrami
Keyword(s):  
Rheumatoid Arthritis ◽  
Bone Mineral Density ◽  
Logistic Regression ◽  
Fracture Risk ◽  
Bone Mineral ◽  
Fat Mass ◽  
Fragility Fracture ◽  
Odds Ratio ◽  
Mineral Density ◽  
History Of

Background:There is an increased risk of low-trauma fracture as bone mineral density (BMD) decreases, however a large proportion of these fragility fractures occur in those without osteoporosis or osteopenia. The widely used FRAX tool uses femoral neck (FN) BMD, amongst other parameters, to predict fracture risk. In those with normal BMD, data is lacking on the weight these other parameters hold in predicting future risk. Indeed, FN BMD can be facultative in the estimation of risk when using FRAX.Objectives:To establish predictors of fragility fracture in a patient cohort referred for BMD estimation, subsequently found to have bilateral FN BMD of greater than 1.Methods:A cohort of patients in the North West of England referred between 2004 and 2014 for BMD estimation, with both left and right FN BMD of greater than 1 were identified. Patient parameters identified and analysed included age at scan, gender, BMD at left hip, body mass index (BMI), fat mass, family history of fracture, alcohol history of 3 or more units per day, smoking status, rheumatoid arthritis (RA), and steroid exposure. Patients with fragility fracture were compared with those without fracture. Chi-square test and T-test were applied to categorical and continuous data respectively. Further univariate and multivariate logistic regression models were fitted to determine parameters associated with future fracture risk.Results:619 patients with bilateral FN BMD of greater than 1 were identified and included in analysis. Mean age at scan was 54 years (SD 11.82) and 542 (87.56%) were female. 92 (14.86%) patients had a fragility fracture. Mean left FN BMD was 1.91 (SD 0.71), and mean right FN BMD was 1.92 (SD 0.68). Results of the univariate analysis are described in Table 1 below.Table 1.Logistic regression analysis of patient parameters with unadjusted and adjusted odds ratios for fragility fracturePredictorUnadjusted odds ratio (95% CI)Odds ratio adjusted for age (95% CI)Odds ratio adjusted for age and gender (95% CI)Age at scan (years)0.99 (0.98-1.01)--Gender1.37 (0.66, 2.84)1.34 (0.64, 2.80)-BMD at left hip0.34 (0.03, 4.05)0.37 (0.03, 4.37)0.50 (0.03, 7.67)BMI1.07 (1.03, 1.10)1.07 (1.03, 1.10)1.07 (1.03, 1.10)Fat mass1.00 (1.00, 1.00)1.00 (1.00, 1.01)1.00 (1.00, 1.01)Parent fractured hip0.99 (0.57, 1.70)0.97 (0.56, 1.68)0.94 (0.54, 1.64)Alcohol (3 or more units/day)1.16 (0.47, 2.86)1.16 (0.47, 2.87)1.16 (0.47, 2.89)Current smoker1.40 (0.89, 2.21)1.40 (0.89, 2.21)1.42 (0.90, 2.23)Rheumatoid arthritis0.83 (0.32, 2.19)0.85 (0.32, 2.24)0.86 (0.34, 2.27)Steroid exposure0.53 (0.30, 0.96)0.53 (0.30, 0.96)0.54 (0.30, 0.98)Conclusion:Steroid exposure and body composition parameters influence fracture risk in this group pf patients with normal BMD, further work will be done looking at the types of fractures and other parameters in this group of patients.Disclosure of Interests:Christopher Saleh: None declared, Marwan Bukhari Speakers bureau: Bristol-Myers Squib, UCB celltech, Roche/Chugai, Pfizer, Abbvie, Merck, Mennarini, Sanofi-aventis, Eli-Lilly, Janssen, Amgen and Novartis., Syed Mujtaba Bilgrami Speakers bureau: Pfizer

Association of bone mineral density with a first-degree family history of diabetes in normoglycemic postmenopausal women

Menopause ◽  
2019 ◽  
Vol 26 (11) ◽  
pp. 1284-1288
Author(s):  
Lijuan Yang ◽  
Xiang Hu ◽  
Hailing Zhang ◽  
Wei Pan ◽  
Weihui Yu ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Family History ◽  
Postmenopausal Women ◽  
Bone Mineral ◽  
Mineral Density ◽  
Family History Of Diabetes ◽  
History Of

scholarly journals Prevalence and risk factors for bone loss in Southern Chinese with rheumatic diseases

2020 ◽  
Author(s):  
Zhuoran Hu ◽  
Shuiming Xu ◽  
Qingyuan Yang ◽  
Jun Qi ◽  
He Lin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Mineral Density ◽  
Bone Loss ◽  
Bone Mineral ◽  
Young Patients ◽  
Mineral Density ◽  
Female Patients ◽  
Southern Chinese ◽  
Male Patients ◽  
Rheumatic Patients

Abstract Objectives: This study is to explore the prevalence of different stages of bone loss and the potential risk factors in rheumatic patients.Method: A cross-sectional study recruits 1,398 rheumatic patients and 302 healthy subjects. Demographic data, blood, and bone mineral density (BMD) tests are collected. Risk factors for bone loss in rheumatic patients are analyzed by logistic regression.Results: (1) Rheumatic patients are consisted of 40.0% rheumatoid arthritis (RA), 14.7% systemic lupus erythematosus (SLE), 14.2% osteoarthritis (OA), 9.2% ankylosing spondylosis (AS), 7.9% gout, 7.0% primary Sjogren syndrome (pSS), 3.8% systemic sclerosis (SSc), and 3.2% mixed connective tissue disease (MCTD). (2) In male patients aged under 50 and premenopausal female patients, the bone mineral density score of AS (53.9%, P<0.001) and SLE (39.6%, P=0.034) patients is lower than the healthy controls (18.2%). (3) Osteopenia and osteoporosis are more prevailing in male patients aged or older than 50 and postmenopausal female patients with RA (P<0.001), OA (P=0.02) and SLE (P =0.011) than healthy counterparts. (4) Those with SLE, RA and AS gain the highest odd ratio of ‘score below the expected range for age’, osteopenia and osteoporosis, respectively. (5) Age, female, low BMI and hypovitaminosis D are found negatively associated with bone loss. Dyslipidemia and hyperuricemia could be protective factors.Conclusion: Young patients with AS and SLE have a significant higher occurrence of bone loss, and older patients with RA, OA and SLE had higher prevalence than healthy counterparts. SLE, RA, SSc and AS were founded significant higher risks to develop into bone loss after adjustment. Age, BMI and gender were commonly-associated with bone loss in all age-stratified rheumatic patients. These findings were not markedly different from those of previous studies.

scholarly journals AB0619 CLINICAL RISK FACTORS, BONE DENSITY AND FALL’S HISTORY AND FRACTURES RELATION: STUDY BY HOSPITAL SURVEY ABOUT 448 CASES

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1344.1-1344
Author(s):  
K. Nassar ◽  
S. Janani
Keyword(s):  
Risk Factors ◽  
Bone Mineral Density ◽  
Risk Factor ◽  
Bone Density ◽  
Fracture Risk ◽  
Bone Mineral ◽  
Independent Risk Factor ◽  
Past History ◽  
Mineral Density ◽  
History Of

Background:Osteoporosis is a disease that affects bone mineral density (BMD) and bone microarchitecture at the origin of an increased risk of fracture. The reduction in bone density assessed by dual-energy X ray absorptiometry (DXA) and fall history represent the first two risk factors of non-vertebral fracture after menopause. Given the high prevalence of osteoporosis among fallers subjects with common risk factors, causing a surisk of fracture. Several publications including the osteoporosis recommendations indicate DXA in women experienced falls in search of bone fragility may justify a treatment for osteoporosis, especially as the FRAX tool does not include at present the fall of history, an important parameter in the assessment of fracture risk.Objectives:Because of the low attention given to the evaluation of falls’risk, the main objective of the study was to determine the prevalence and the relationship between the past history of fall, reduction of bone mineral density and prevalent fracture.Methods:Transversal and descriptive epidemiological cohort study conducted for 24 months in 448 patients referred by physicians regularly use prescription of BMD. The realization of this exploration by the same DXA-Hologic in the rheumatology department at Ibn Rochd University Hospital was the criterion for entry into the study. All patients were interviewed on the same day on the risk factors for osteoporosis and fractures justifying the prescription of a BMD.Results:Data included 413 women and 35 men. Most women were postmenopausal (89.6%). The average age was 59 years (σ = 13.40), 33.7% were ≥ 65 years. The mean BMI was at 27.50 (σ = 5,2). 18.5% of patients had at least a history of falls in the previous 12 months and 22.5% a history of fracture after a low-energy trauma. 42.9% were osteoporotic and 57.1% had osteopenia in at least one of these sites: lumbar spine, femoral neck, total hip. We did not find significant association between BMD osteoporosis and fall history (p = 0.916). Thus, cases of osteoporosis fractures were not statistically associated with a fall (p = 0.170). Also, the falls were occurring than 18.4% of osteopenic patients (p = 0.220). However, in our study, the fall was an independent risk factor for fracture (p = 0.003) and osteopenic fractures were significantly higher among fallers (p = 0.009 and 0.006 respectively, a drop of history and at least one past fall history).Conclusion:The fall history is a independent risk factor for fracture. This risk is particularly important in case of fragility bone densitometry. The clinical history and fall risk factors should be taken into consideration in the assessment of fracture risk and in the anti-ostoporotique treatment strategy. Thus, the fall seems to be a legitimate indication for DXA and as a parameter to be integrated into the assessment of fracture risk by the FRAX score.References:[1]MH. Edwards, K. Jameson, H. Denison, NC.Harvey, Sayer A. Aihie, EM Dennison, and C Cooper. Clinical risk factors, bone density and fall history in the predection of incident fracture among men and women. Bone. 2013; 52(2): 541–547.Table 1.Multivariate Logistic Regression Results: Adjustment for predictors factors of fallsVariablesOR (95% IC)p-valueAge ≥ 65 ans0,986 (0,412-2,357)0,974Past history of fracture4,271 (1,719-10,611)0,02Walking aid11,214 (2,815-44,670)0,01Vision disturbances8,587 (3,540-20,829)<0,001Rhumatoid arthritis8,047 (2,218-29,192)0,02Diabete3,194 (1,217-8,382)0,018Corticosteroid ≥ 3 mois0,603 (0,156-2,331)0,463Smoking0,241 (0,013-4,518)0,341Ostéopenia (-1 ≤ T-score < -2,5)2,204 (0,875-5,552)0,094Disclosure of Interests:None declared.

Bone Mineral Density in Transfusion Independent Thalassemia Patients.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3353-3353
Author(s):  
Zahra Pakbaz ◽  
Zhe Zhang ◽  
Ellen Fung ◽  
Nancy Sweeters ◽  
Sylvia Singer ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Family History ◽  
Bone Mineral ◽  
Z Score ◽  
Low Bone Mass ◽  
Mineral Density ◽  
Patients Âgés ◽  
Z Scores ◽  
History Of ◽  
The Mean

Abstract Low bone mineral density (BMD) is commonly seen in regularly transfused thalassemia patients; however, there have been few reports for bone mineral density assessment in transfusion independent thalassemia patients. The present report includes the results of BMD assessments in patients with transfusion independent thalassemia who were referred to the bone density clinic through 2002–2006. BMD was evaluated by dual energy x-ray absorptiometry (DXA, Hologic Delphi A). A convenience sample of 24 patients (Females=15) with transfusion independent thalassemia were measured with a mean age of 22.1 ± 13.8 years. Subjects younger than 10 yrs old (n = 7) underwent scans for Lumbar spine (LS; L1-L4) and whole body (WB), patients ages 10–20 (n = 5) were assessed for LS, WB, and non-dominant hip, and for patients older than 20 (n = 12), LS and hip scans were completed. Z-scores specific for age and gender were generated using Zemel BS et al.(J. Bone Min Res 2004) database. Z-scores less than −2.0 were considered as low bone density. Calcium intake was assessed by a brief food frequency questionnaire. Past medical history, medications, history of fractures, and family history of osteoporosis were obtained by chart review and patient interview. Data is presented as Mean ± SD. T-test was used to assess differences in continuous variables. The mean LS Z-score (n = 24) was −1.5 ± 1.0 and the mean hip Z-score (n = 17) was −0.5 ± 1.1. Mean WB Z-score (n = 10) was −2.0 ± 1.2. There was a significant (p<0.001) difference between spine and hip Z-scores. Overall 46% had a Z-score less than −2.0. Thirty-three percent of patients have spine Z-scores of less than −2.0 and 25% spine Z-scores between −2.0 and −1.0. Average spine Z-score in patients younger than 10 years old (n=7) was −1.6 ± 0.5. In WB scans, 50% of the patients had WB Z-scores worse than −2.0. None of the young patients (5–9 yrs; n = 7) consumed inadequate intake of calcium (< 2/3 of RDA age specific) while 75% of patients ages 10–20 (n = 4) years old consumed inadequate intake of calcium (dietary + supplement). Neither spine nor hip Z-score was related to patients’ gender, age, and calcium intake. Two patients reported fractures in the past and two reported family history of osteoporosis. Six patients had delayed puberty and one has hypogonadism. Seven patients have short stature. This data suggests that low bone mass is not only a problem in transfused thalassemia patients, but is also observed in non-transfused patients. The significance and pathophysiology of low bone mass should be studied further in non-transfused patient population, especially in younger children.

scholarly journals SAT0034 CLINICAL SIGNIFICANCE OF ANTI-CARBAMYLATED PROTEIN ANTIBODIES IN PREMENOPAUSAL RHEUMATOID ARTHRITIS WOMEN: RELATION TO DISEASE ACTIVITY AND BONE LOSS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 947.2-947
Author(s):  
R. Elnemr ◽  
R. Bastawy ◽  
R. Ghazala ◽  
M. Abdelrazek ◽  
N. Elsawy
Keyword(s):  
Rheumatoid Arthritis ◽  
Physical Activity ◽  
Bone Mineral Density ◽  
Body Mass Index ◽  
Serum Level ◽  
Bone Loss ◽  
Disease Activity ◽  
Bone Mineral ◽  
Mineral Density ◽  
Local Bone

Background:Anti carbamylated protein anti carP are present in patients with Rheumatoid Arthritis RA and are associated with erosions. However their association with systemic or local bone loss in RA patients is still not confirmed.Objectives:The purpose of this study was to measure the serum level of anti carP in premenopausal women with RA and determine its relation to disease activity and bone loss.Methods:This case control study was conducted on forty eight RA premenopausal female patients diagnosed according to 2010 ACR/EULAR criteria and forty eight ages and body mass index matched healthy premenopausal females. RA patients with other autoimmune diseases, viral hepatitis malignancy or erosive joint disease and systemic diseases that affect bone quality were excluded from the study. All RA women were subjected to history taking, clinical examination, assessment of disease activity using disease activity score-28 DAS28 and clinical disease activity index CDAI functional assessment using health assessment questionnaire HAQ physical activity assessment using international physical activity questionnaire short form IPAQ fatigue assessment using modified fatigue impact scale MFIS, routine laboratory investigations, serological tests as well as Anti carP using ELISA kit. Moreover the bone mineral density was measured by a lunar Prodigy Advanced DEXA scanner system and plain x-ray of both hands and wrists in the anteroposterior view was done to assess the juxta articular osteopenia and erosions.Results:Anti carP level was significantly higher in RA patients than in healthy controls table 1. The serum level of anti carP had a significant positive correlation with RA DAS, CDAI, HAQ, IPAQ, MFIS and erosion and joint space narrowing in original sharp score. Also the anti carP had a significant negative correlation with the bone mineral density BMD of spine. The AUC of anti carP level showed a high level of accuracy AUC 0.857 figure 1 and the calculated cutoff value >65 can precisely discriminate subjects with RA from those without RA with 85.42% sensitivity and 85.11% specificity.Table 1.Comparison between the patient and healthy groups according to anti carp levelAnti-carpRA patientsHealthy controlUpMin – Max15.0 – 90.01.0 – 78.50322.0*<0.001*Mean ± SD71.24 ± 14.7045.99 ± 21.99Median (IQR)72.75 (70.5–78.3)55.0 (32.5–61.5)Figure 1.ROC curve for anti carP to diagnose RA patients from healthy subjectsConclusion:Anti carbamylated antibodies were higher in premenopausal RA women compared to ages and body mass index matched healthy women. Anti carP are associated with higher RA disease activity, increased disability and decreased physical activity. Moreover anti carP are associated with systemic trabecular bone loss manifested by decreased bone mineral density of the spine as well as local bone loss as manifested by increased number of joint erosions in premenopausal RA women.References:[1] Regueiro C, Ortiz AM, Boveda MD, Castañeda S, Gonzalez-Alvaro I, Gonzalez A. Association of high titers of anti-carbamylated protein antibodies with decreased bone mineral density in early arthritis patients. PLoS ONE 2018; 13(8):e0202583.Disclosure of Interests:None declared

scholarly journals Risk Management of Osteoporosis in Postmenopausal Women; A Study of Women In a Teaching Hospital

2016 ◽  
Vol 8 (11) ◽  
pp. 36 ◽  
Author(s):  
Chander Kumar Lohana ◽  
Nafisa Samir
Keyword(s):  
Risk Factors ◽  
Bone Mineral Density ◽  
Postmenopausal Women ◽  
Bone Mineral ◽  
Public Awareness ◽  
Clinical Manifestations ◽  
Radiology Department ◽  
Premature Menopause ◽  
Mineral Density ◽  
History Of

<p><strong>BACKGROUND: </strong>Postmenopausal females are susceptible to osteoporosis due to clinical manifestations. It not only causes morbidity; but, is considered to strikingly decline quality of life among patients. Among different developing regions, the prevalence rate of osteoporosis among postmenopausal women is alarming in the face of poor management and awareness about its risk factors.</p><p><strong>AIM:</strong> The aim of this study was to investigate the incidence of osteoporosis and its known risk factors among postmenopausal women appearing for bone mineral density in Karachi.</p><p><strong>METHODOLOGY: </strong>This descriptive cross-sectional study was undertaken from the period of “March 2006 to March 2007” in “Aga Khan University hospital”, Karachi. A total of 245 females, who came to the radiology department at Aga Khan Hospital for DXA scan, were recruited. All the relevant data was collected through questionnaires. Data analysis was undertaken by using SPSS version 11.5 to generate frequencies and proportion percentages.</p><p><strong>RESULTS: </strong>The study demonstrated that 99 females (40%) amongst all subjects were osteopenic, 114 females (47%) were osteoporotic; whereas, 32 females (13%) were normal. A decline was observed in bone mineral density with advancing age and duration of menopause. The distribution of osteoporosis was observed to be common in women, who had more children, low BMI, history of prior fractures, history of premature menopause, and were avoiding exercise.</p><p><strong>CONCLUSION:</strong> This study confirmed a high frequency of osteoporosis and osteopenia in postmenopausal women. Therefore, early screening is required to detect the decrease in bone mineral density among postmenopausal females to prevent fragility fracture. There is an imperative requirement for vast public awareness in this regard.</p>

scholarly journals Time-averaged disease activity of rheumatoid arthritis associated with long-term bone mineral density changes

2020 ◽  
Vol 11 ◽  
pp. 204062232098151
Author(s):  
Chung-Yuan Hsu ◽  
Jia-Feng Chen ◽  
Yu-Jih Su ◽  
Ying-Chou Chen ◽  
Han-Ming Lai ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Bone Mineral Density ◽  
Bone Loss ◽  
Disease Activity ◽  
Bone Mineral ◽  
Osteoporosis Treatment ◽  
High Disease Activity ◽  
Mineral Density

Background: Rheumatoid arthritis (RA) is associated with poor bone mineral density (BMD). We designed the current study owing to the lack of long-term prospective studies regarding whether a high disease activity leads to increased bone loss. Methods: We have continually enrolled patients with RA. According to the average disease activity score in 28 joints based on the erythrocyte sedimentation rate (DAS28-ESR) during follow-up, the patients were classified into remission, low disease activity, and moderate or high disease activity groups. Patients were examined with dual-energy X-ray absorptiometry at baseline and after 3 years of follow-up. BMD changes were compared among the groups. Results: We have studied 477 patients. Overall BMD was significantly reduced from baseline to the 3-year follow-up ( p < 0.05). After stratifying according to the time-averaged DAS28-ESR levels and use of anti-osteoporosis treatment (AOT), the BMD values of the femur and spine significantly increased in patients in the remission group with AOT. The BMD changes of different DAS28-ESR patients were further compared using the generalized estimation equation model. For the patients on AOT, the negative change in femoral BMD values of the moderate or high activity group was significant when compared with the remission group with positive BMD changes (regression coefficient, –0.038; 95% confidence interval, –0.055 to –0.021). Conclusion: For RA patients, if remission is achieved, AOT can better improve BMD, especially in the femur. In addition, moderate or high disease activity will lead to significant bone loss; therefore, disease activity must be actively controlled.

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