Article

Increased frequency of osteoporosis and BMD below the expected range for age among South Korean women with rheumatoid arthritis

Department of Internal Medicine, Pusan National University School of Medicine, Busan, South Korea.
International Journal of Rheumatic Diseases (Impact Factor: 1.47). 06/2012; 15(3):289-96. DOI: 10.1111/j.1756-185X.2012.01729.x
Source: PubMed

ABSTRACT

To compare the frequency of osteoporosis and bone mineral density (BMD) below the expected range for age between female patients with rheumatoid arthritis (RA) and healthy subjects and to determine risk factors for bone loss in female patients with RA.
Two hundred and ninety-nine patients with RA and 246 age-matched healthy subjects were included in this study. BMD in the lumbar spine, femoral neck and total hip were measured with dual-energy X-ray absorptiometry. A T-score of -2.5 or lower in postmenopausal women was defined as osteoporosis, and a Z-score -2.0 or lower in females prior to menopause was defined as below the expected range for age.
The frequency of osteoporosis in the RA patients (22.1%) was significantly higher than in healthy subjects (11.4%) at either the spine or hip (P = 0.014). The occurrence of BMD below the expected range for age in RA patients (7.8%) was also significantly higher than in healthy subjects (1.0%, P = 0.015). In 299 female patients with RA, higher age, lower body mass index and postmenopausal status were significantly associated with the lumbar spine and hip BMD reduction. Of disease-related variables, glucocorticoid use was independently associated with reduction of hip BMD.
The prevalence of osteoporosis in the RA patients was 1.9 times higher than in healthy subjects. Glucocorticoid use was a risk factor for generalized bone loss in female RA patients.

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    • "Despite of the reported association between OP and RA, there have been a number of controversial opinions in the literature. Kim et al. investigated the effects of disease modifying anti-rheumatic drug (DM- ARD) use on fracture risk in RA patients and their study suggests that medication of RA does not consequently decrease fracture risk in OP [10]. Moreover, the relationship between the use of corticosteroids in RA and OP remains debated and unclear [11] [12]. "
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    • "Glucocorticoids (e.g., dexamethasone and prednisone) are anti-inflammatory and immune suppressor agents that are able to reduce the inflammation and the progression of RA, through the inhibition of cytokines secretion and osteoclasts activation [6] [7] [8] [9] [10] [11] [12] [13] [14] [15]. However, even if they represent a first-line treatment in patients with RA, their use is limited for the development of serious ADRs such as loss of bone mass, increased risk of fractures, infections, diabetes and hypertension [16] [17] [18]. The DMARDs group, includes both nonbiological and biological drugs; between the DMARDs, methotrexate (MTX) due to "
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