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

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.

scholarly journals Prevalence and Risk Factors for Bone Loss in Rheumatoid Arthritis Patients from South China: modeled by three methods

2021 ◽  
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 and healthy controls 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. Case records, laboratory tests, and bone mineral density (BMD) results were included. Multivariable logistic regression analysis, least absolute shrinkage, selection operator (LASSO), and random forest (RF) was 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 detective 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, aging, lower body mass index, and increased serum uric acid were associated with 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 detective sites are recommended to check routinely. TNFi usage in the last year might benefit bone mass.

scholarly journals AB0915 BONE MINERAL DENSITY AND FRACTURE FREQUENCY IN PREMENOPAUSAL WOMEN WITH RHEUMATIC DISEASES

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1759.2-1759
Author(s):  
N. Toroptsova ◽  
O. Dobrovolskaya ◽  
O. Nikitinskaya ◽  
N. Demin ◽  
A. Smirnov ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Vitamin D ◽  
Lumbar Spine ◽  
Serum Vitamin ◽  
Premenopausal Women ◽  
Healthy Controls ◽  
C Reactive Protein ◽  
Mineral Density ◽  
Serum Vitamin D ◽  
Reactive Protein

Background:The onset of the disease in young and middle age is typical for rheumatic diseases (RDS), but most studies on osteoporosis were conducted in patients (pts) older than 50 years, which included postmenopausal women.Objectives:To assess bone mineral density (BMD), fracture frequency and the factors associated with low BMD in premenopausal women with RDs.Methods:160 women (median age, 36 [29; 43] years): 120 pts with RDs (43 rheumatoid arthritis (RA), 53 systemic sclerosis (SSc) and 24 psoriatic arthritis (PsA)) and 40 age-matched healthy controls were enrolled in the study. We performed a dual-energy X-ray absorptiometry (DXA, Hologic Discovery A, USA) to measure BMD in lumbar spine, femoral neck and total hip. BMD decreasing grade was evaluated by the Z-score <-2SD. All pts were interviewed using a unified questionnaire including assessment of daily dietary calcium intake. Serum vitamin D, C-reactive protein and erythrocyte sedimentation rate (ESR) measurements were done.Results:25% pts with RDs and only 8% healthy controls have low BMD (p=0.02). RA, SSc and PsA pts had low BMD in 37%, 21% and 13%, respectively, that was more often than in healthy women (p=0.004, p=0.046 and p= 0.081, respectively). 9,3% RA pts and 7,5% SSc pts had low energy fractures. BMD of RDs pts in all areas of measurement demonstrated a direct correlation with height, weight, body mass index, and serum vitamin D concentration and an inverse correlation with the cumulative dose of glucocorticoids. Also, proximal femur BMD inversely correlated with RDs duration. BMD of femoral neck and total hip inversely correlated with C-reactive protein level in SSc pts. In RA women we found a direct correlation between lumbar spine and femur neck BMD and ESR.Conclusion:25% of premenopausal women with RDs had reduced BMD and needed monitoring and osteoporosis prevention, while 9.3% pts with RA and 7.5% women with SSc needed anti-osteoporotic treatment.Disclosure of Interests:None declared

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&lt;0.01-0.0005-0.002,0.00050.292Sex-0.094-0.113,-0.075&lt;0.01-0.101-0.129,-0.072&lt;0.01BMI (mg/m2)0.0080.008,0.0101&lt;0.010.01130.019,0.013&lt;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 Thecomparisonofserumbiomarkersin patients with osteoarthritisand rheumatoidarthritis

2018 ◽  
Vol 6 (2) ◽  
pp. 1-11
Author(s):  
Almandlawi S G ◽  
Ahmed A S
Keyword(s):  
Rheumatoid Arthritis ◽  
Vitamin D ◽  
Alkaline Phosphatase ◽  
Parathyroid Hormone ◽  
Calcium Phosphate ◽  
Serum Vitamin ◽  
Type Ii Collagen ◽  
Healthy Controls ◽  
Type Ii ◽  
Serum Vitamin D

Introduction: This study aims to assess the status of serum vitamin D, parathyroid hormone, type II collagen, calcium, phosphate,albumin, and alkaline phosphatase in osteoarthritis and rheumatoidarthritis patients and to study their association with rheumatoid arthritis disease activity. Materials and Methods: This prospectivecross-sectional study was conducted at the clinical analysis department, College of Pharmacy, Hawler Medical University in 2017.They study samples were collected at Rizgary Teaching Hospitalduring the period September 2015 to January 2016. A total of(N=156) participants were included: (N=53) patients with rheumatoid arthritis (RA), (N=53) with osteoarthritis (OA), and (N=50)healthy controls. Enzyme Linked Immuno Sorbent Assay kits determined serum vitamin D, parathyroid hormone, and type II collagen; and serum albumin, calcium, phosphate and alkaline phosphatase, were determined by standard colorimetric methods. Resultsand Discussion: Statistically significant higher levels of parathyroid hormone and type II collagen, with lower levels of Vitamin D,were found in the osteoarthritis group than the rheumatoid arthritisgroup and the healthy controls (P=0.007, P<0.001, P= 0.005) respectively. Multiple linear regression showed a statistically significant difference in serum type II collagen as a dependent variable, inpatients suffering from RA or OA compared to the healthy controlgroup; after adjusting for the effect of other independent studyvariables, there was a mean increase of (45.90 nmol/L, P<0.001)in RA patients, and OA patients showed greater levels of type IIcollagen (73.950 nmol/L) than the health control group (P<0.001).Conclusions: Elevated type II collagen levels, in conjunction witha low vitamin D status, may be strong discriminator between osteoarthritis and rheumatoid arthritis patients.

scholarly journals Bone Loss, Osteoporosis, and Fractures in Patients with Rheumatoid Arthritis: A Review

2020 ◽  
Vol 9 (10) ◽  
pp. 3361
Author(s):  
Patrice Fardellone ◽  
Emad Salawati ◽  
Laure Le Monnier ◽  
Vincent Goëb
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Bone Loss ◽  
Interleukin 1 ◽  
Bone Destruction ◽  
Fragility Fractures ◽  
Systemic Effect ◽  
Vertebral Fracture Assessment ◽  
Mineral Density ◽  
Accurate Treatment

Rheumatoid arthritis (RA) is often characterized by bone loss and fragility fractures and is a frequent comorbidity. Compared with a matched population, RA patients with fractures have more common risk factors of osteoporosis and fragility fractures but also risk factors resulting from the disease itself such as duration, intensity of the inflammation and disability, and cachexia. The inflammatory reaction in the synovium results in the production of numerous cytokines (interleukin-1, interleukin-6, tumor necrosis factor) that activate osteoclasts and mediate cartilage and bone destruction of the joints, but also have a systemic effect leading to generalized bone loss. Regular bone mineral density (BMD) measurement, fracture risk assessment using tools such as the FRAX algorithm, and vertebral fracture assessment (VFA) should be performed for early detection of osteoporosis and accurate treatment in RA patients.

Vitamin D and Ulcerative Colitis: Is There a Relationship with Disease Extent?

2018 ◽  
Vol 37 (3) ◽  
pp. 208-213
Author(s):  
Stefania Chetcuti Zammit ◽  
John Schembri ◽  
Anthea Pisani ◽  
Sarah Vella ◽  
Matthias Azzopardi ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Vitamin D ◽  
Activity Index ◽  
Serum Vitamin ◽  
Healthy Controls ◽  
Mineral Density ◽  
Disease Extent ◽  
Serum Vitamin D ◽  
Vitamin D Levels ◽  
Low Serum

Introduction: Patients with ulcerative colitis (UC) can suffer from low serum vitamin D that can result in complications such as low bone mineral density. It can also reflect underlying disease severity. Methods: One hundred and ninety-seven patients previously diagnosed with UC from 2 European centers were prospectively recruited through the out-patient clinics. Clinical features (Montreal Classification, age, gender, previous and current medications, surgery), disease activity (Simple Clinical Colitis Activity Index [SCCAI]), blood investigations including serum inflammatory markers, and serum vitamin D were analyzed. The vitamin D levels were compared to a group of age- and gender-matched healthy controls. Results: Mean vitamin D levels were lower in patients with UC (54.6 nmol/L) than in controls (80.7 nmol/L; p = 0.0001). Mean vitamin D levels was lowest in patients with extensive UC (E3; p = 0.0001). Serum vitamin D was not significantly different across treatment groups (p = 0.876). There was no statistical difference in vitamin D levels across patients receiving calcium and vitamin D supplements (p = 0.35) and there was no statistical correlation with SCCAI (p = 0.22). Conclusions: This study confirms the existence of low serum vitamin D in patients with UC when compared to healthy controls. It also provides evidence of an existing relationship between disease extent and serum vitamin D.

scholarly journals AB0611 OSTEOPOROSIS IN RHEUMATOID ARTHRITIS: A NECESSARY EVIL?

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1341.1-1341
Author(s):  
S. Athimni ◽  
S. Bouden ◽  
A. Ben Tekaya ◽  
A. Dghais ◽  
O. Saidane ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Bone Loss ◽  
Sex Ratio ◽  
Biological Treatment ◽  
Protective Factor ◽  
Local Population ◽  
Advanced Age ◽  
Mineral Density ◽  
The Mean

Background:Rheumatoid arthritis (RA) is a chronic inflammatory disease that is characterized by local and general bone loss. Osteoporosis (OP) is one of the most frequent comorbidities associated with RA. Many factors are incriminated in bone loss in RA such as inflammation, glucocorticoid (GC) use, and immobility.Objectives:-To determine the prevalence of OP in a population of actual RA patients.-To determine the risk factors of bone mineral density (BMD) reductionMethods:One hundred-fifty-two RA followed in the rheumatology department between 2015-2020 were enrolled in the study. The diagnosis of RA was established according to the American College of rheumatology/European League Against Rheumatism (ACR/EULAR) criteria 2010. BMD in lumbar spine and total hip was systematically measured in the recruited patients. Measures were taken with dual-energy x-ray absorptiometry (DEXA), and age-specific values were compared with pooled values from a local population of healthy subjects free from earlier fractures.Results:The mean age was 42.7±13 years. The sex ratio M/F was 0.24. The mean onset disease was 6±1.8 years. Fifty-sex patients (36.3%) were receiving conventional treatment DMARDs and 96 (63.6%) were under biological treatment. 35.5% were taken steroids with mean doses at 7.7±3.3mg/day. RF and ACPA were positive respectively in 87.3% and 82.4% of the patients. The mean disease activity score DAS28CRP was 4.8 ±2.7.Sixty-eight point eight 68.8% of the RA population had bone loss: 37.5% had osteopenia and 31.3% had OP. Regarding the OP group, sex ratio M/F was 0.45. The mean age was 42±5.3 years. Among the 31 women, 77.4% had postmenopausal OP. The BMI average was 31.18 ± 6.19 kg/m2. Fifteen patients (33.33%) had OP in the hip site and 20 patients had OP in the lumbar site (48.8%). Ten patients had both trabecular and cortical OP.Advanced age, glucocorticoid use and high DAS28CRP were independent risk factors for OP (respectively p=0.04, p=0.02 and p=0.01). Body mass index, smoking, disease duration high Health Assessment Questionnaire (HAQ) score (p=0.545) and smoking (p=0.326) were not associated with high risk of OP. The biological treatment was not a protective factor in OP (p=0.972). All the population subjects were free from earlier fractures, the fractural risk estimated by dint of the mean FRAXTM score was at 1.4 ± 2.3.Conclusion:Previous studies estimated that, approximately, osteoporosis affected one-third of RA patients which is in concordance with our study. Advanced age, glucorticoid treatment and severe disease were the most common risk factor in our study.Disclosure of Interests:None declared.

scholarly journals Bone mineral density in rheumatoid arthritis patients 1 year after adalimumab therapy: arrest of bone loss

2008 ◽  
Vol 68 (3) ◽  
pp. 373-376 ◽  
Author(s):  
C A Wijbrandts ◽  
R Klaasen ◽  
M G W Dijkgraaf ◽  
D M Gerlag ◽  
B L F van Eck-Smit ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Bone Mineral Density ◽  
Lumbar Spine ◽  
Bone Loss ◽  
Disease Activity ◽  
Bone Mineral ◽  
Joint Disease ◽  
Mineral Density ◽  
Femur Neck ◽  
Adalimumab Therapy

Objective:To explore the effects of anti-tumour necrosis factor (TNF)α antibody therapy on bone mineral density (BMD) of the lumbar spine and femur neck in patients with rheumatoid arthritis (RA).Methods:A total of 50 patients with active RA (DAS28⩾3.2) who started adalimumab (40 mg subcutaneously/2 weeks) were included in an open label prospective study. All patients used stable methotrexate and were allowed to use prednisone (⩽10 mg/day). The BMD of the lumbar spine and femur neck was measured before and 1 year after start of treatment.Results:Disease activity at baseline (28-joint Disease Activity Score (DAS28)) and disease duration were inversely correlated with femoral neck BMD and lumbar spine BMD (p<0.05). Mean BMD of lumbar spine and femur neck remained unchanged after 1 year of adalimumab therapy (+0.3% and +0.3%, respectively). Of interest, a beneficial effect of prednisone on change in femur neck BMD was observed with a relative increase with prednisone use (+2.5%) compared to no concomitant prednisone use (−0.7%), (p = 0.015).Conclusion:In contrast to the progressive bone loss observed after conventional disease-modifying antirheumatic drug therapy, TNF blockade may result in an arrest of general bone loss. Consistent with previous observations, the data also suggest that the net effect of low-dose corticosteroids on BMD in RA may be beneficial, possibly resulting from their anti-inflammatory effects.

Relationship Between Nutrient Intake and Vitamin D Status in Osteoporotic Women

2007 ◽  
Vol 77 (6) ◽  
pp. 376-381 ◽  
Author(s):  
de Souza Genaro ◽  
de Paiva Pereira ◽  
de Medeiros Pinheiro ◽  
Szejnfeld ◽  
Araújo Martini
Keyword(s):  
Vitamin D ◽  
Mineral Metabolism ◽  
Sodium Intake ◽  
Serum Vitamin ◽  
Cross Sectional Study ◽  
Dietary Intakes ◽  
Mineral Density ◽  
Cross Sectional ◽  
Serum Vitamin D ◽  
Dietary Records

Vitamin D is essential for maintaining calcium homeostasis and optimizing bone health. Its inadequacy is related to many factors including dietary intake. The aim of the present study was to evaluate serum 25(OH)D and its relationship with nutrient intakes in postmenopausal Brazilian women with osteoporosis. This cross-sectional study comprised 45 free-living and assisted elderly at São Paulo Hospital. Three-day dietary records were used to assess dietary intakes. Bone mineral density was measured with a dual-energy X-ray absorptiometer (DXA). Blood and urine sample were collected for analysis of biochemical markers of bone and mineral metabolism. Insufficiency of vitamin D was observed in 24.4% of the women and optimal levels (≥ 50 nmol/L) were observed in 75.6%. Parathyroid hormone was above the reference range in 51% of the participants. The mean calcium (724 mg/day) and vitamin D (4.2 μ g/day) intakes were lower than the value proposed by The Food and Nutrition Board and sodium intake was more than two-fold above the recommendation. Higher levels of serum 25(OH)D were inversely associated with sodium intake. Dietary strategies to improve serum vitamin D must focus on increasing vitamin D intake and should take a reduction of sodium intake into consideration.

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