Risk factors associated with cervical spine lesions in patients with rheumatoid arthritis: an observational study

Abstract Background Few reports have described the association between rheumatoid arthritis (RA) cervical lesions and osteoporosis, especially in patients with vertical subluxation (VS) that could be induced by the collapse of lateral masses in the upper cervical spine. Therefore, this study aimed to investigate the prevalence and risk factors for cervical lesions in patients with RA under current pharmacological treatments with biological agents, and to investigate the relationship between osteoporosis and VS development. Methods One hundred eighty-five consecutive patients with RA who underwent both cervical plain radiography and bone mineral density (BMD) scanning were enrolled. RA cervical lesions included atlantoaxial subluxation (AAS), VS, and subaxial subluxation (SAS). We assigned patients with AAS, VS, or SAS to the cervical-lesion group, and all other patients to the non-cervical-lesion group. Radiological findings, BMD, and clinical data on RA were collected. We used multivariate logistic regression analyses to assess the risk factors for cervical lesions in patients with RA. Results The cervical-lesion and non-cervical-lesion groups included 106 and 79 patients, respectively. There were 79 patients with AAS, 31 with VS, and 41 with SAS. The cervical-lesion group had a younger age of RA onset, longer RA disease duration, higher RA stage, and lower femoral neck BMD than the non-cervical-lesion group. Multivariate analyses showed that the risk factors for RA cervical lesions were prednisolone usage, biological agent usage, and higher RA stage. Prednisolone usage and femoral neck BMD were the risk factors for VS. Conclusions Cervical lesions were confirmed in 57 % of the patients. Prednisolone usage, biological agent usage, and higher RA stage were significant risk factors for cervical lesions in patients with RA. The general status of osteoporosis might contribute to the development of VS.

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Risk Factors Associated With Cervical Spine Lesions in Patients With Rheumatoid Arthritis: The Role of Biological Agents

10.21203/rs.3.rs-145161/v1 ◽

2021 ◽

Author(s):

Yosuke Uchino ◽

Naomi Kobayashi ◽

Takayuki Higashi ◽

Tetsuhiko Inoue ◽

Yuichi Mochida ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Risk Factors ◽

Femoral Neck ◽

Disease Duration ◽

Significant Risk ◽

Biological Agents ◽

Cervical Lesion ◽

Lesion Group ◽

Cervical Lesions ◽

Mineral Density

Abstract Purpose To investigate the prevalence and risk factors of cervical lesions in patients with rheumatoid arthritis (RA) under current pharmacological treatments with biological agents. Methods One hundred and eighty-five consecutive patients with RA who underwent both cervical plain radiography and bone mineral density (BMD) scanning were enrolled. RA cervical lesions included atlantoaxial subluxation (AAS), vertical subluxation (VS), and subaxial subluxation (SAS). We assigned patients with AAS, VS, or SAS to the cervical-lesion group, and all other patients to the non-cervical-lesion group. Radiological findings, BMD, and clinical data on RA were collected. We used multivariate logistic regression analyses to assess the risk factors of cervical lesions in patients with RA. Results The cervical-lesion and non-cervical-lesion groups included 106 and 79 patients, respectively. There were 79 patients with AAS, 31 with VS, and 41 with SAS. The cervical-lesion group had younger age of onset, longer RA disease duration, and lower femoral neck BMD than those in the non-cervical-lesion group. Multivariate analyses showed that the risk factors of RA cervical lesions were RA disease duration, prednisolone usage, biological agents, and femoral neck BMD. Femoral neck BMD in patients with VS was lower than in those without VS. Conclusions Cervical lesions were confirmed in 57% of the patients. RA duration, prednisolone usage, biological agents, and femoral neck BMD were significant risk factors of cervical lesions in patients with RA. The general status of osteoporosis might contribute to the development of VS.

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P129 Predictors of low bone mineral density in rheumatoid arthritis

Rheumatology ◽

10.1093/rheumatology/keab247.124 ◽

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.

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Prevalence and risk factors for bone loss in rheumatoid arthritis patients from South China: modeled by three methods

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04403-5 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Zhuoran Hu ◽

Lei Zhang ◽

Zhiming Lin ◽

Changlin Zhao ◽

Shuiming Xu ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Risk Factors ◽

Lumbar Spine ◽

Bone Loss ◽

South China ◽

Serum Vitamin ◽

Tumor Necrosis Factor Inhibitor ◽

Healthy Controls ◽

Mineral Density ◽

Serum Vitamin D

Abstract Background To explore the prevalence of bone loss among patients with rheumatoid arthritis (RA) and healthy controls (HC) and further explored the risk factors for osteopenia and osteoporosis of RA patients. Methods A cross-sectional survey was undertaken in four hospitals in different districts in South China to reveal the prevalence of bone loss in patients. Case records, laboratory tests, and bone mineral density (BMD) results of patients were collected. Traditional multivariable logistic regression analysis and two machine learning methods, including least absolute shrinkage selection operator (LASSO) and random forest (RF) were for exploring the risk factors for osteopenia or osteoporosis in RA patients. Results Four hundred five patients with RA and 198 HC were included. RA patients had lower BMD in almost BMD measurement sites than healthy controls; the decline of lumbar spine BMD was earlier than HC. RA patients were more likely to comorbid with osteopenia and osteoporosis (p for trend < 0.001) in the lumbar spine than HC. Higher serum 25-hydroxyvitamin D3 level and using tumor necrosis factor inhibitor in the last year were protective factors; aging, lower body mass index, and increased serum uric acid might be risk factors for bone loss. Conclusions RA patients were more prone and earlier to have bone loss than HC. More attention should be paid to measuring BMD in RA patients aging with lower BMI or hyperuricemia. Besides, serum vitamin D and all three measurement sites are recommended to check routinely. TNFi usage in the last year might benefit bone mass.

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POS1112 COMPARISON OF TWO APPROACHES IN FRACTURES RISK ASSESSMENT IN WOMEN WITH RHEUMATOID ARTHRITIS AND GLUCOCORTICOID USE

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.2448 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 836.1-836

Author(s):

N. Grygorieva ◽

V. Povoroznyuk

Keyword(s):

Rheumatoid Arthritis ◽

Risk Assessment ◽

Clinical Practice ◽

Lumbar Spine ◽

Femoral Neck ◽

Fracture Risk ◽

Fracture Risk Assessment ◽

Lifestyle Modifications ◽

Mineral Density ◽

Dxa Scan

Background:Nowadays, FRAX is the most useful tool for osteoporotic fracture risk assessment that is included in many guidelines. Rheumatoid arthritis (RA) and glucocorticoid (CG) use are two crucial factors for osteoporotic fractures included in FRAX algorithm. According to the last ACR guidelines for the treatment of GC-induced osteoporosis [1], it was recommended to divide the patients into three groups of fracture risk (high, medium and low) that have a great impact on treatment decision. Recently, we received own Ukrainian thresholds [2] for the national version of FRAX that are age-dependent and now widely used in clinical practice.Objectives:Our study was aimed to compare two approaches (ACR-2017 and Ukrainian (2019) recommendations) in fracture risk assessment in women with RA and GC use.Methods:We examined 195 females with RA aged 40-89 years old who took GC (at dose ≥5 mg/d for ≥3 months) due to RA. The 10-year probabilities of major osteoporotic (MOFs) and hip fractures (HFs) were calculated with and without bone mineral density (BMD) using the Ukrainian FRAX model [3]. The DXA was used to measure the lumbar spine, femoral neck and total body BMDs; T and Z scores were calculated (DISCOVERY Wi, Hologic, Inc., USA).Results:FRAX indexes for MOFs and HFs without BMD in patients with RA and GC were (Me [25-75Q]) 12.0 [8.1-18.0] and 4.2 [1.7-7.2] %. The correspondent FRAX indexes with BMD were 13.5 [8.5-20.0] and 5.1 [1.8-8.7] %.50 % of examined women had previous fractures and 20 % had previous vertebral fractures. BMD of the femoral neck consisted of 0.62±0.13 and L1-L4 BMD was 0.85±0.15 g/cm2. 89 % of females had low BMD at the lumbar spine and / or femoral neck (49 % osteoporosis and 40 % osteopenia).61 % of women required antiosteoporotic treatment according to ACR-2017 guideline (17.4 % of them a hadhigh risk of MOF and 43.1 % moderate one) without BMD measurement and 64 % of subjects after DXA scan.According to Ukrainian national guideline, 57 % of patients required antiosteoporotic treatment without BMD measurement and 42 % – after additional DXA examination. After BMD measurement in subjects who required the DXA scan, 78.2 % of females with RA and GC use required antiosteoporotic treatment (additionally to calcium and vitamin D, lifestyle modifications).Conclusion:Approximately 60 % of subjects with RA and GC use required antiosteoporotic treatment without additional DXA measurement according to correspondent FRAX indexes from both guidelines. The proportion of women requiring treatment after DXA scan is slightly higher according to Ukrainian recommendations. It proves that both of them can be used effectively in daily clinical practice for fracture risk assessment in females with RA.References:[1]Buckley L, Guyatt G, Fink HA, Cannon M et al. 2017 American College of Rheumatology Guideline for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis & Rheumatology, 2017;69(8), 1521–1537. DOI:10.1002/art.40137[2]Povoroznyuk V, Grygorieva N, Kanis JA et al. Ukrainian FRAX: criteria for diagnostics and treatment of osteoporosis. Pain. Joint. Spine. 2019;9(4):7-16. DOI: 10.22141/2224-1507.9.4.2019.191921[3]Povoroznyuk VV, Grygorieva NV, Kanis JA et al. Epidemiology of hip fracture and the development of FRAX in Ukraine. Arch Osteoporos. 2017;12(1):53. DOI: 10.1007/s11657-017-0343-2.Disclosure of Interests:Nataliia Grygorieva Consultant of: Servier, Redis, Vladyslav Povoroznyuk: None declared.

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Incidence and risk factors for cervical lesions in patients with rheumatoid arthritis under the current pharmacologic treatment paradigm

Modern Rheumatology ◽

10.1080/14397595.2016.1253649 ◽

2016 ◽

Vol 27 (4) ◽

pp. 593-597 ◽

Cited By ~ 5

Author(s):

Takashi Kaito ◽

Shirou Ohshima ◽

Hiroyasu Fujiwara ◽

Takahiro Makino ◽

Kazuo Yonenobu ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Risk Factors ◽

Pharmacologic Treatment ◽

Cervical Lesions ◽

Treatment Paradigm

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FRI0068 LIPID PROFILE AND BONE MINERAL DENSITY IN PATIENTS WITH RHEUMATOID ARTHRITIS: IS THERE AN ADDED RISK OF OSTEOPOROSIS?

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4715 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 610.1-611

Author(s):

B. Touil ◽

H. Azzouzi ◽

O. Lamkhanat ◽

F. Chennouf ◽

I. Linda

Keyword(s):

Rheumatoid Arthritis ◽

Bone Mineral Density ◽

Lumbar Spine ◽

Linear Regression ◽

Femoral Neck ◽

Lipid Profile ◽

Density Lipoprotein ◽

Mineral Density ◽

High Tc ◽

High Concentrations

Background:Bone is a target in many inflammatory rheumatic diseases such as rheumatoid arthritis (RA). It has been supposed that an atherogenic lipid profile could be associated with lower bone mineral density (BMD) and vertebral fractures (VF).Objectives:We aimed to evaluate the relationship between the lipid profile, BMD and the presence of VF in RA patients.Methods:A cross sectional study was conducted in a population of 169 established RA. In each subject we evaluated the body mass index (BMI), tobacco use, alcohol consumption, presence of diabetes and high blood pression, lipid profile (total cholesterol (TC), High density lipoprotein cholesterol (HDLc), low density lipoprotein cholesterol (LDLc), triglycerides (TG), and VF. RA characteristics were also assessed (disease duration, disease activity score (DAS), auto antibodies, corticosteroid intake, and secondary sjogren’s syndrome). BMD was measured by dual energy X-ray absorptiometry (DXA) in lumbar spine and femoral neck. Logistic and linear regression were performed with SPSS 20, both BMD and VF were assessed as dependent variables.Results:The mean age was 55.5±11.9 years, with a female predominance (152 women). The average BMI was 26.79 ± 5.36. We had 24.3 % of hypertensive patients and 16.6 % of diabetics. The average lipid concentrations were 4.39±1 mmol/L for TC, 1.293±0.36 mmol/L for HDLc, 2.74±0.80 mmol/L for LDLc and 1.25±0.62 mmol/L for TG. At the linear regression there was no correlation between plasma lipid concentrations and BMD, whether at the lumbar spine or the femoral neck. However we found a significant correlation between VF and high TC concentrations (p=0.043, OR: 2.864, 95% IC [1.036-7.922]). At the multivariate regression, high TC levels were still associated with VF, adjusted in BMI, age and the duration of corticosteroid use (p=0.006, OR: 6.07, 95% CI[1.69- 21.77]). The same finding was observed between high concentrations of HDLc and the prevalence of VF adjusted in the same variables (p=0.006, OR: 197.01, 95% CI [4.64-8363.51]).Conclusion:Although there was no relation between lipid plasma levels and BMD in our population. There was a significant association between high concentrations of TC, HDLc and the prevalence of VF.Disclosure of Interests:None declared

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Predictive Risk Factors of Cervical Spine Instabilities in Rheumatoid Arthritis

Spine ◽

10.1097/brs.0000000000001853 ◽

2017 ◽

Vol 42 (8) ◽

pp. 556-564 ◽

Cited By ~ 20

Author(s):

Yoshiki Terashima ◽

Takashi Yurube ◽

Hiroaki Hirata ◽

Daisuke Sugiyama ◽

Masatoshi Sumi

Keyword(s):

Rheumatoid Arthritis ◽

Risk Factors ◽

Cervical Spine ◽

Predictive Risk

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Risk factors for decreased bone mineral density in men with type 2 diabetes.

Diabetes Mellitus ◽

10.14341/dm12383 ◽

2021 ◽

Vol 23 (5) ◽

pp. 424-433

Author(s):

Olga N. Fazullina ◽

Anton I. Korbut ◽

Maksim V. Dashkin ◽

Vadim V. Klimontov

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Lumbar Spine ◽

Femoral Neck ◽

Fat Mass ◽

Free Testosterone ◽

Mineral Density ◽

T Score ◽

25 Oh Vitamin D

BACKGROUND: Type 2 diabetes and osteoporosis are widespread diseases in the middle-aged and elderly people. Most studies of osteoporosis in patients with type 2 diabetes have been performed in women; meantime risk factors for lowering bone mineral density (BMD) in men have been little studied.AIMS: to identify risk factors for decreased BMD at the lumbar spine, femoral neck and forearm in men with type 2 diabetes.METHODS: Eighty two men from 50 to 75 years old, with duration of diabetes for at least one year, were included in the study. Individuals with known risk factors for secondary osteoporosis were not included. Twenty-three men with normal BMD having no diabetes or obesity were acted as control. The T-score at the lumbar spine, femoral neck and forearm of a non-dominant arm, as well as body composition parameters, were evaluated by dual-energy X-ray absorptiometry. The levels of hormones that affect bone metabolism (parathyroid hormone, free testosterone, 25-OH vitamin D) were measured in blood serum by ELISA. Risk factors for reducing BMD were identified using multivariate regression analysis and receiver operating characteristic (ROC) curves.RESULTS: Among patients with diabetes, 49 individuals had normal BMD and 33 showed decreased T-score values (<-1 SD). Free testosterone <5.92 pg/ml was predictor for decreased BMD at the lumbar spine (OR=4.4, p=0.04). For femoral neck, the risk factors were body weight <95.5 kg (OR=2.8, p=0.04), total fat mass <27 kg (OR=3.3, p=0.03), truncal fat mass<17.5 kg(OR=4.5, p=0.006), android (central abdominal) fat mass <3.2 kg(OR=4.0, p=0.01), gynoid (hip) fat mass <3.5 kg(OR=3.3, p=0.02), and lean mass <59 kg(OR=3.0, p=0.04). Risk factors for reduced BMD at the forearm were diabetes duration>15.5 years (OR=3.7, p=0.03) and HbA1c <8.15% (OR=3.8, p=0.03). Parathyroid hormone and 25-OH-vitamin D did not predict BMD independently.CONCLUSIONS: In men with type 2 diabetes, low free testosterone is a risk factor for decreased BMD in the lumbar spine, and diabetes duration is a risk factor for decreased BMD in the forearm. The presence of obesity is associated with an increase in BMD in the femoral neck; a high HbA1c is associated with an increase in BMD in the forearm.

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