Generalized Bone Loss as a Predictor of Three-Year Radiographic Damage in African American Patients With Recent-Onset Rheumatoid Arthritis

Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL 35294, USA.
Arthritis & Rheumatology (Impact Factor: 7.76). 08/2010; 62(8):2219-26. DOI: 10.1002/art.27510
Source: PubMed


To examine the association between baseline bone mineral density (BMD) and radiographic damage at 3 years of disease duration in a longitudinal cohort of African Americans with recent-onset rheumatoid arthritis (RA).
African American RA patients with a disease duration of <2 years (n = 141) were included in the study. All patients underwent baseline BMD measurements (femoral neck and/or lumbar spine) using dual x-ray absorptiometry. T scores were calculated using normative data from the general population of African Americans. Patients were categorized as having osteopenia/osteoporosis (T score less than or equal to -1) or as being healthy. Hand and wrist radiographs, obtained at baseline and at 3 years of disease duration, were scored using the modified Sharp/van der Heijde method. The association between baseline BMD and total radiographic score at 3 years of disease was examined using multivariable negative binomial regression.
At baseline, the mean age and the mean disease duration were 52.4 years and 14.8 months, respectively; 85.1% of the patients were women. The average total radiographic scores at baseline and at 3 years of disease were 2.4 and 5.7, respectively. In the final reduced multivariable model, adjusting for age, sex, anti-cyclic citrullinated peptide antibody positivity, and the presence of radiographic damage at baseline, the total radiographic score at 3 years disease in patients with osteopenia/osteoporosis of the femoral neck was twice that in patients with normal bone density, and the difference was statistically significant (P = 0.0084). No association between lumbar spine osteopenia/osteoporosis and radiographic score was found.
Our findings suggest that reduced generalized BMD may be a predictor of future radiographic damage and support the hypothesis that radiographic damage and reduced generalized BMD in RA patients may share a common pathogenic mechanism.

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    • "In our RA cohort, 43.3% had normal BMD, 43.3% had osteopenia, and 13.3% had osteoporosis at the lumber spine. Zhang et al17 found that 38.6% of their subjects had either osteopenia or osteoporosis at the lumbar spine, and 44.9% had either osteopenia or osteoporosis at the femoral neck. "
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