Background:Rheumatoid arthritis (RA) is a determinant risk factor of osteoporosis. BMD is clearly defined as diagnosis criteria of osteoporosis in Japan; that is less than -2.5 with T-score measured with dual-energy X-ray absorptiometry (DXA). The marker of T-score <-2.5 is widely used worldwide; however, the testing system is very expensive, preventing its extensive adoption.Objectives:We tried to evaluate BMD not measuring with DXA, but the other method that substituting DXA with another X-ray picture of hand that is routinely taken for Sharp/van der Heijde score (SHS) calculation.Methods:Patient with RA, who met the American College of Rheumatology/European League Against Rheumatism classification criteria, visited our institute has been routinely calculated SHS in taking X-ray pictures of bilateral hands and feet at first consultation. Cortical thickness was calculated from mid-portion of third metacarpal bone in X-ray picture that was taken for the calculation of SHS as taking cancellous bone diameter of the third metacarpal bone from transverse diameter at the same point. We set Cortical Thickness Ratio (CTR) as cortical thickness relative to transverse thickness (Figure 1). BMD measurements at the lumbar spine (LS) and femoral neck (FN) were obtained, and BMD values are presented as g/cm2and T-score showing dissociation of the BMD compared with the mean BMD in healthy 30-year-old of the same sex with standard deviation was also presented. Patient with RA who underwent SHS calculation and BMD measurement at first consultation was picked up for the study. Relationship between BMD and the other parameters such as sex (male/female), age, disease duration (years), ACPA titer, RF titer, body mass index (BMI), CTR, the HAQ score, DAS28-CRP, SHS, PS-VAS, tartrate-resistant acid phosphatase-5b value (TRACP-5b), previous treatment for osteoporosis and RA before initial consultation (pTx_OP and pTx_RA) (Yes/No) at initial consultation was evaluated with linear regression analysis.T-score<-2.5 was statistically evaluated with binary regression analysis for the parameters that demonstrated significant correlation in multivariate linear regression analysis.Then, Cut-off index (COI) of CTR for the BMD represented with T-score <-2.5 for both of LS and FN was evaluated with Receivers Operation Characteristics technique (ROC). Sensitivity, specificity, area under curve, odds ratio with 95% confidence interval (95%CI) for T-score <-2.5 was also calculated.Results:A total of 300 patients were picked up for the study. BMDs were 0.867 and 0.682 with 0.203 and 0.143 for standard deviations, that means T-score was -1.93 and -1.86 with 1.64 and 1.15 for standard deviations in LS and FN, respectively. Mean transverse width of third metacarpal bone was 7.3 mm and thickness of the cortex was 2.00 mm, so CTR was 0.279 in average and 0.124 for standard deviation.In linear regression analysis, BMD in LS demonstrated significant correlation with sex, CTR, and DAS28-CRP, while BMD in FN demonstrated significant correlation with sex, age, and CTR.In binary regression analysis, CTR and DAS28-CRP demonstrated significant positive correlation with T-score <-2.5 in LS, while age and CTR demonstrated significant correlation in FN.In ROC, cut-off index of CTR was 0.25 in both of LS and FN, and sensitivities demonstrated 67.9% and 76.1%, and specificity demonstrated 83.0% and 81.6% in LS and FN, respectively. Area under curve was 0.78 and 0.81 with 4.17 (95%CI: 2.51 – 6.92) and 4.90 (95%CI: 2.75 – 8.73) of odds ratios for LS and FN, respectively (Figure 2).Conclusion:Results of this cross-sectional study encourages our hypothesis that thickness of cortical bone relative to full thickness in the long bone reflects BMD. CTR correlated with BMD in both of LS and FN. CTR of third metacarpal bone was suggested that has close correlation with BMD in both LS and FN. CTR could be strong candidate marker for screening of osteoporosis in patient with RA with the index less than 0.25.Disclosure of Interests:None declared
A Matrix Effect Correction Method for Portable X-ray Fluorescence Data
