QUS and BMD: discriminatory ability in patients with RA and controls with and without vertebral deformities

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Ann Rheum Dis. 2004 Aug;63(8):945-51.

Quantitative ultrasound and bone mineral density: discriminatory ability

in patients with rheumatoid arthritis and controls with and without

vertebral deformities.

ORstavik RE, Haugeberg G, Uhlig T, Mowinckel P, Kvien TK, Falch JA,

Halse JI.

Department of Rheumatology, Diakonhjemmet Hospital, Box 23, Vinderen,

N-0319 Oslo, Norway. ragnhild.orstavik@...

BACKGROUND: Quantitative ultrasound (QUS) is a reliable tool for

discriminating between subjects with and without vertebral deformities

in postmenopausal osteoporosis. Less is known about osteoporosis caused

by inflammatory diseases or corticosteroid use. OBJECTIVES: (1) To

compare in patients with rheumatoid arthritis the ability of QUS and

dual energy x ray absorptiometry (DXA) to discriminate between those

with and without vertebral deformities; (2) to explore whether the

results are similar in population based controls. METHODS: Standardised

lateral radiographs of the spine were obtained from 210 patients with

rheumatoid arthritis aged over 50 years and 210 individually matched

controls. Vertebral deformities were assessed morphometrically and

semiquantitatively. All participants underwent bone measurements by DXA

(Lunar Expert) and QUS (Lunar Achilles+). Receiver operating curve (ROC)

analysis was used to compare the discriminating ability of BMD and QUS

measurements in patients and controls with and without vertebral

deformities. Analyses were repeated in patients stratified according to

corticosteroid use. RESULTS: For all bone measurements except lumbar

spine in the rheumatoid arthritis group, BMD discriminated significantly

between the patients with and without vertebral deformities, and the

results were similar to those obtained in controls. Among current

corticosteroid users, neither QUS nor DXA could discriminate between

subjects with and without vertebral deformities.

CONCLUSIONS: These findings support QUS as an alternative tool for

identifying patients at risk of having vertebral deformities in

rheumatoid arthritis, although results should be interpreted with

caution in current users of corticosteroids.

PMID: 15249321

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