Reduced bone mineral density in early RA is associated with radiological joint damage at baseline and after 2 years in women

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J Rheumatol. 2003 Dec; 30(12): 2590-6.

Reduced bone mineral density in early rheumatoid arthritis is associated

with radiological joint damage at baseline and after 2 years in women.

Forslind K, Keller C, Svensson B, Hafstrom I; BARFOT Study Group.

Rheumatology Section, Department of Medicine, Helsingborg's lasarett,

Helsingborg, Sweden.

OBJECTIVE: Data suggest that reduced bone mass may be associated with

radiological damage in rheumatoid arthritis (RA). We investigated if

patients with reduced bone mineral density (BMD) at onset of RA had more

radiological damage at onset and after 2 years than patients with normal

BMD. METHODS: BMD at lumbar spine and hip was measured in 204 patients

with recent RA at presentation. At baseline and after 2 years,

radiographs of hands and forefeet were evaluated according to the Larsen

method. At the same time-points, Disease Activity Score (DAS 28) and

functional disability (the Stanford Health Assessment Questionnaire,

HAQ) were assessed. RESULTS: The 134 women and 70 men had a mean age of

55 and 61 years, respectively. Reduced bone mass (RBM, Z score < or =

1.0 SD) in at least one site was found in 46.0% of women and 62.5% of

men. T and Z scores correlated significantly with Larsen scores both at

baseline and after 2 years for the total patient cohort. Calculated

separately for the sexes, significant correlations were found only for

women. Women but not men with reduced bone mass and osteoporosis had

higher Larsen scores at baseline and after 2 years than those without.

From a stepwise multiple logistic regression analysis Z score trochanter

and baseline C-reactive protein were selected as independent predictors

of joint damage, measured as proportion over the median Larsen scores.

This model could explain about 25% of the " variance " in outcome

(Nagelkerke R2 = 0.27).

CONCLUSION: Reduced BMD at onset of RA in women was associated with a

higher Larsen score at baseline and after 2 years, indicating that the

development of reduced bone mass and joint destruction in RA may have a

common pathophysiological mechanism.

PMID: 14719199

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