RESEARCH - The relationship between focal erosions and generalized osteoporosis in postmenopausal women with RA

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Arthritis Rheum. 2009 May 28;60(6):1624-1631.

The relationship between focal erosions and generalized osteoporosis

in postmenopausal women with rheumatoid arthritis.

DH, Finkelstein JS, Shadick N, Leboff MS, Winalski CS, Stedman

M, Glass R, Brookhart MA, Weinblatt ME, Gravallese EM.

Brigham and Women's Hospital, Boston, Massachusetts.

OBJECTIVE: Among rheumatoid arthritis (RA) patients who have had the

disease for 10 years, more than half have focal erosions, and the risk

of fracture is doubled. However, there is little information about the

potential relationship between focal erosions and bone mineral density

(BMD). The aim of this study was to determine whether lower BMD is

associated with higher erosion scores among patients with RA.

METHODS: We enrolled 163 postmenopausal women with RA, none of whom

were taking osteoporosis medications. Patients underwent dual x-ray

absorptiometry at the hip and spine and hand radiography, and

completed a questionnaire. The hand radiographs were scored using the

Sharp method, and the relationship between BMD and erosions was

measured using Spearman's correlation coefficients and adjusted linear

regression models.

RESULTS: Patients had an average disease duration of 13.7 years, and

almost all were taking a disease-modifying antirheumatic drug.

Sixty-three percent were rheumatoid factor (RF) positive. The median

modified Health Assessment Questionnaire score was 0.7, and the

average Disease Activity Score in 28 joints was 3.8. The erosion score

was significantly correlated with total hip BMD (r = -0.33, P <

0.0001), but not with lumbar spine BMD (r = -0.09, P = 0.27). Hip BMD

was significantly lower in RF-positive patients versus RF-negative

patients (P = 0.02). In multivariable models that included age, body

mass index, and cumulative oral glucocorticoid dose, neither total hip

BMD nor lumbar spine BMD was significantly associated with focal

erosions.

CONCLUSION: Our results suggest that hip BMD is associated with focal

erosions among postmenopausal women with RA, but that this association

disappears after multivariable adjustment. While BMD and erosions may

be correlated with bone manifestations of RA, their relationship is

complex and influenced by other disease-related factors.

PMID: 19479876

http://www.ncbi.nlm.nih.gov/pubmed/19479876

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