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Ruggiero C, Caffarelli C, Calsolaro V, Tafaro L, Riuzzi F, Bubba V, Napoli N, Ferracci M, Mecocci P, Giusti A, Rinonapoli G. Osteoporosis in Older Men: Informing Patient Management and Improving Health-Related Outcomes. Drugs Aging 2025; 42:21-38. [PMID: 39775765 DOI: 10.1007/s40266-024-01163-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2024] [Indexed: 01/11/2025]
Abstract
Osteoporosis has been usually considered a female disease, generally causing more fracture risk and complications in adult and older women compared to older men. While vertebral fractures occur in a small proportion of men during middle age, men generally fracture about 10 years later than women, with significant increases in fracture risk after about age 75. Independent of age, men experiencing fragility fractures have a higher risk of life-threatening events compared to women, but the risk of secondary fragility fracture overlaps between men and women. Often, male osteoporosis recognizes the overlap between secondary causes and primary osteoporosis risk factors. Assessment through physical examination, history, and laboratory tests is recommended, with dual-energy X-ray absorptiometry of bone density being the preferred diagnostic test for osteoporosis in men. A treatment program should include awareness of diet and vitamin D status, fall risk reduction, and pharmaceutical therapy. Medications that are fracture-reducing in older women should also achieve fewer fractures in older men; however, there is a paucity of studies in men with the primary outcome of fracture risk reduction. Most older men with osteoporosis should be treated with oral or intravenous bisphosphonates, denosumab especially when on androgen deprivation therapy, and initial anabolic treatment should be considered for men at very high risk of fracture. This review summarizes the main features of osteoporosis and fragility fractures in men and reports findings from the available pharmacological and non-pharmacological studies conducted in men.
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Affiliation(s)
- Carmelinda Ruggiero
- Orthogeriatric and Geriatric Units, Gerontology and Geriatrics Section, Department Medicine and Surgery, Geriatric Institute, University of Perugia Medical School, S. Maria della Misericordia Hospital, C Building, 4° Floor, Room 20, S. Andrea delleFratte, Perugia, Italy.
| | - Carla Caffarelli
- Division Internal Medicine, Department Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Valeria Calsolaro
- Geriatric Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Laura Tafaro
- Division Internal Medicine, Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Francesca Riuzzi
- Department of Medicine and Surgery, Interuniversity Institute of Myology, University of Perugia Medical School, Perugia, Italy
| | - Valentina Bubba
- Orthogeriatric and Geriatric Units, Gerontology and Geriatrics Section, Department Medicine and Surgery, Geriatric Institute, University of Perugia Medical School, S. Maria della Misericordia Hospital, C Building, 4° Floor, Room 20, S. Andrea delleFratte, Perugia, Italy
| | - Nicola Napoli
- Unit of Endocrinology and Diabetes, Department of Medicine, Foundation Campus Bio-medico University, Rome, Italy
| | - Marika Ferracci
- Orthogeriatric and Geriatric Units, Gerontology and Geriatrics Section, Department Medicine and Surgery, Geriatric Institute, University of Perugia Medical School, S. Maria della Misericordia Hospital, C Building, 4° Floor, Room 20, S. Andrea delleFratte, Perugia, Italy
| | - Patrizia Mecocci
- Orthogeriatric and Geriatric Units, Gerontology and Geriatrics Section, Department Medicine and Surgery, Geriatric Institute, University of Perugia Medical School, S. Maria della Misericordia Hospital, C Building, 4° Floor, Room 20, S. Andrea delleFratte, Perugia, Italy
| | - Andrea Giusti
- Department Medical Specialties, Rheumatology and Bone Metabolism, ASL3, Genoa, Italy
| | - Giuseppe Rinonapoli
- Orthopedics and Traumatology Department, Department of Medicine and Surgery, University of Perugia Medical School, Perugia, Italy
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Brance ML, Razzini A, Pons-Estel BA, Quagliato NJ, Jorfen M, Berbotto G, Brun LR. Whole-hand and regional bone mineral density involvement in rheumatoid arthritis. REUMATOLOGIA CLINICA 2023; 19:555-559. [PMID: 38056980 DOI: 10.1016/j.reumae.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/22/2023] [Indexed: 12/08/2023]
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by symmetric polyarthritis that can lead to joint deformity, disability, and osteoporosis. We aimed to evaluate whole hand and regional BMD in RA patients compared to controls. In addition, we evaluated the BMD of dominant versus non-dominant hands in healthy subjects. We included adult female and male RA patients and control subjects matched by age, sex, and BMI. BMD (g/cm2) was measured by DXA in lumbar spine (LS), whole hand, and three regions of interest: carpus, metacarpal bones, and phalanges. Results: 44 control subjects (49.5±11.8 y) and 60 with RA (52.7±12.7 y) were included. Significant lower BMD in RA patients was found in LS (-8.7%), dominant whole hand (-9.5%), carpus, metacarpal bones, and phalanges, and non-dominant whole hand (-8.7%), metacarpal bones, and phalanges compared to controls. A significant positive correlation was found between LS and whole-hand BMD (dominant r=.63, non-dominant r=.67). Finally, the whole hand, metacarpal bones, and carpus BMD measurements were significantly higher in the dominant hand compared to the non-dominant hand without differences in the phalangeal ROI. In conclusion, hand BMD was significantly lower in RA patients compared to control subjects and there was a significant correlation with LS BMD. We demonstrated that BMD measurements of the whole-hand, and different ROI (carpus, metacarpal bones, and phalanges) by DXA would be an easily reproducible technique to evaluate bone loss. In addition, the whole hand, metacarpal bones and carpus BMD measurements were significantly higher in the dominant hand compared to the non-dominant hand without differences in the phalanges.
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Affiliation(s)
- María Lorena Brance
- Reumatología y Enfermedades Óseas, Rosario, Argentina; Laboratorio de Biología Ósea, Universidad Nacional de Rosario, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina.
| | - Agustín Razzini
- Reumatología y Enfermedades Óseas, Rosario, Argentina; Laboratorio de Biología Ósea, Universidad Nacional de Rosario, Argentina
| | - Bernardo A Pons-Estel
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (CREAR), Rosario, Argentina
| | | | | | | | - Lucas R Brun
- Laboratorio de Biología Ósea, Universidad Nacional de Rosario, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
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Simon D, Kleyer A, Englbrecht M, Stemmler F, Simon C, Berlin A, Kocijan R, Haschka J, Hirschmann S, Atreya R, Neurath MF, Sticherling M, Rech J, Hueber AJ, Engelke K, Schett G. A comparative analysis of articular bone in large cohort of patients with chronic inflammatory diseases of the joints, the gut and the skin. Bone 2018; 116:87-93. [PMID: 30048820 DOI: 10.1016/j.bone.2018.07.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/12/2018] [Accepted: 07/22/2018] [Indexed: 12/23/2022]
Abstract
Chronic inflammatory diseases are associated with bone loss. While the occurrence of systemic bone loss is well described in chronic inflammatory diseases, the impact of these conditions on articular bone has not been systematically investigated. Recent refinements in high-resolution CT assessment of the joints now allow the accurate measure of articular bone composition. In this study 476 subjects comprising healthy individuals and patients with anticitrullinated protein antibody (ACPA)-positive rheumatoid arthritis (RA), ACPA-negative RA, Crohn's disease (CD), ulcerative colitis (UC), psoriasis (PsO) and psoriatic arthritis (PsA) were subjected to high-resolution quantitative computed tomography (HR-pQCT) of the hand. Metacarpal heads were assessed for total, trabecular and cortical volumetric bone mineral density (vBMD). Only ACPA+RA, but not the remaining inflammatory diseases (ACPA-RA, CD, UC, PsO, PsA) showed significant (p < 0.001) loss of articular bone affecting both the trabecular and the cortical compartments. Age and body mass index were also associated with articular bone changes, the former with lower, the latter with higher articular bone mass. In multivariate models, presence of ACPA+RA was an independent factor for articular bone loss. Among chronic inflammatory diseases ACPA+RA is the most potent precipitator for articular bone loss pointing out the role of autoimmunity in the development of articular bone disease in the context of chronic inflammatory disease.
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Affiliation(s)
- David Simon
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Matthias Englbrecht
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Fabian Stemmler
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Christoph Simon
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Andreas Berlin
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Roland Kocijan
- St. Vincent Hospital, Medical Department II, VINFORCE Study Group, Academic Teaching Hospital of Medical University of Vienna, Vienna, Austria
| | - Judith Haschka
- St. Vincent Hospital, Medical Department II, VINFORCE Study Group, Academic Teaching Hospital of Medical University of Vienna, Vienna, Austria
| | - Simon Hirschmann
- Department of Internal Medicine 1, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Raja Atreya
- Department of Internal Medicine 1, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Markus F Neurath
- Department of Internal Medicine 1, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Michael Sticherling
- Department of Dermatology, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Juergen Rech
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Axel J Hueber
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Klaus Engelke
- Institute of Medical Physics, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany.
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Micro-structural bone changes in early rheumatoid arthritis persist over 1-year despite use of disease modifying anti-rheumatic drug therapy. BMC Musculoskelet Disord 2017; 18:521. [PMID: 29228959 PMCID: PMC5725933 DOI: 10.1186/s12891-017-1888-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 12/01/2017] [Indexed: 12/30/2022] Open
Abstract
Background We used High Resolution – peripheral Quantitative CT (HR-pQCT) imaging to examine peri-articular bone quality in early rheumatoid arthritis (RA) and explore whether bone quality improved over 12-months in individuals receiving care consistent with practice guidelines. Methods A 1-year longitudinal cohort study (Baseline and 12-months) evaluating individuals with early RA compared to age/sex-matched peers. Personal demographic and health and lifestyle information were collected for all. Whereas, active joint count (AJC28), functional limitation, and RA medications were also collected for RA participants. HR-pQCT imaging analyses quantified bone density and microstructure in the Metacarpal Head (MH) and Ultra-Ultra-Distal (UUD) radius at baseline and 12-months. Analyses included a General Linear Modelling repeated measures analyses examined main effects for disease, time, and interaction on bone quality. Results Participants (n = 60, 30 RA/30 NRA); 80% female, mean age 53 (varying from 21 to 74 years). At baseline, RA participants were on average 7.7 months since diagnosis, presenting with few active joints (AJC28: 30% none, remaining 70% Median 4 active joints) and minimal self-reported functional limitation (mHAQ-DI0–3: 0.56). At baseline, 29 of 30 RA participants had received one or more non-biologic disease-modifying anti-rheumatic drugs (DMARD);13 in combination with glucocorticoid and 1 in combination with a biologic medication. One participant only received glucocorticoid medication. Four RA participants withdrew leaving 26 pairs (n = 52) at 12-months; 23 pairs (n = 46) with UUD and 22 pairs (n = 44) with MH baseline and 12-month images to compare. Notable RA/NRA differences (p < 0.05) in bone quality at all three sites included lower trabecular bone density and volume, more rod-like trabeculae, and larger and more variable spaces between trabeculae; fewer trabeculae at the UUD and MH2 sites; and lower cortical bone density and volume in the MH sites. Rate of change over 12-months did not differ between RA/NRA participants which meant there was also no improvement over the year in RA bone quality. Conclusions Early changes in peri-articular bone density and microstructure seen in RA are consistent with changes more commonly seen in aging bone and are slow or resistant to recover despite well controlled inflammatory joint symptoms with early DMARD therapy. Electronic supplementary material The online version of this article (10.1186/s12891-017-1888-3) contains supplementary material, which is available to authorized users.
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Simon D, Kleyer A, Stemmler F, Simon C, Berlin A, Hueber AJ, Haschka J, Renner N, Figueiredo C, Neuhuber W, Buder T, Englbrecht M, Rech J, Engelke K, Schett G. Age- and Sex-Dependent Changes of Intra-articular Cortical and Trabecular Bone Structure and the Effects of Rheumatoid Arthritis. J Bone Miner Res 2017; 32:722-730. [PMID: 27787923 DOI: 10.1002/jbmr.3025] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/07/2016] [Accepted: 10/21/2016] [Indexed: 12/22/2022]
Abstract
The objective of this cross-sectional study was to define normal sex- and age-dependent values of intra-articular bone mass and microstructures in the metacarpal heads of healthy individuals by high-resolution peripheral quantitative computed tomography (HR-pQCT) and test the effect of rheumatoid arthritis (RA) on these parameters. Human cadaveric metacarpal heads were used to exactly define intra-articular bone. Healthy individuals of different sex and age categories and RA patients with similar age and sex distribution received HR-pQCT scans of the second metacarpal head and the radius. Total, cortical, and trabecular bone densities as well as microstructural parameters were compared between 1) the different ages and sexes in healthy individuals; 2) between metacarpal heads and the radius; and 3) between healthy individuals and RA patients. The cadaveric study allowed exact definition of the intra-articular (intracapsular) bone margins. These data were applied in measuring intra-articular and radial bone parameters in 214 women and men (108 healthy individuals, 106 RA patients). Correlations between intra-articular and radial bone parameters were good (r = 0.51 to 0.62, p < 0.001). In contrast to radial bone, intra-articular bone remained stable until age 60 years (between 297 and 312 mg HA/cm3 ) but decreased significantly (p < 0.001) in women thereafter (237.5 ± 44.3) with loss of both cortical and trabecular bone. Similarly, RA patients showed significant (p < 0.001) loss of intra-articular total (263.0 ± 44.8), trabecular (171.2 ± 35.6), and cortical bone (610.2 ± 62.0) compared with sex- and age-adjusted controls. Standard sex- and age-dependent values for physiological intra-articular bone were defined. Postmenopausal state and RA led to significant decrease of intra-articular bone. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- David Simon
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Fabian Stemmler
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Christoph Simon
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Andreas Berlin
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Axel J Hueber
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Judith Haschka
- St. Vincent Hospital, Medical Department II, VINFORCE Study Group, Academic Teaching Hospital of Medical University of Vienna, Vienna, Austria
| | - Nina Renner
- Department of Trauma and Orthopaedic Surgery, University Hospital of Erlangen, Erlangen, Germany
| | - Camille Figueiredo
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany.,Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Winfried Neuhuber
- Institute of Anatomy, Department I, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
| | - Thomas Buder
- Institute of Anatomy, Department I, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias Englbrecht
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Juergen Rech
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Klaus Engelke
- Institute of Medical Physics (IMP), University of Erlangen, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
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Mandl P, Kainberger F, Friberg Hitz M. Imaging in osteoporosis in rheumatic diseases. Best Pract Res Clin Rheumatol 2016; 30:751-765. [PMID: 27931966 DOI: 10.1016/j.berh.2016.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 06/06/2016] [Accepted: 08/04/2016] [Indexed: 12/25/2022]
Abstract
Osteoporosis is a common comorbidity of all major rheumatic diseases, and manifests itself both systemically and locally. Systemic bone loss manifests because of several factors, primarily inflammation, immobility, and commonly used medical treatment for rheumatic diseases. Local bone loss manifests as periarticular demineralization and bone erosion due to local release of inflammatory agents and cytokines, which promote bone resorption. All these factors contribute to the phenomenon of arthritis-associated osteoporosis. This review summarized the currently available and used methods that play a role in the diagnosis and monitoring of osteoporosis and in the detection of osteoporotic fractures.
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Affiliation(s)
- Peter Mandl
- Division of Rheumatology, 3rd Department of Internal Medicine, Medical University of Vienna, 18-20 Währinger Gürtel, 1090 Vienna, Austria.
| | - Franz Kainberger
- Division of Neuro- and Musculoskeletal Radiology, Department of Radiology and Nuclear Medicine, Medical University of Vienna, 18-20 Währinger Gürtel, 1090 Vienna, Austria.
| | - Mette Friberg Hitz
- Department of Medicine, Endocrinology, Zealand University Hospital, Lykkebaekvej 1, 4600 Koege, Denmark.
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Rothschild BM. Return to clinical in contrast to serologically-based diagnoses. World J Rheumatol 2016; 6:1-8. [DOI: 10.5499/wjr.v6.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 09/19/2015] [Accepted: 11/17/2015] [Indexed: 02/06/2023] Open
Abstract
The future of rheumatology is predicated upon a return to basics. The advent and facile availability of laboratory testing led to reduction of emphasis on clinical skills. Recognition that immunologic abnormalities are not limited to individuals who clearly have related pathology provides new motivation for reorientation of training programs to assure that graduates have appropriate information gathering, diagnostic and procedural skills. Inadequate accessibility to rheumatologic care requires innovative approaches and especially training and educating those individuals who provide primary care. While the rheumatologist can elicit the patient’s history remotely, telerheumatology will be feasible only when the individual interacting physically with the patient has confidence in their examination skills and when those skills have been validated. Named syndromes or diseases will be modified to avoid impugning the individual or compromising their future access to health, disability and life insurance. Interventions will be pursued in a more cost-effective, evidence-based manner. The future of rheumatology is dependent upon the rheumatologist’s ability to amortize the inadequate reimbursement for direct patient interaction, depending on skills of interpretation of standard X-rays, ultrasound performance and results.
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Iwata T, Ito H, Furu M, Hashimoto M, Fujii T, Ishikawa M, Yamakawa N, Terao C, Azukizawa M, Hamamoto Y, Mimori T, Akiyama H, Matsuda S. Periarticular osteoporosis of the forearm correlated with joint destruction and functional impairment in patients with rheumatoid arthritis. Osteoporos Int 2016; 27:691-701. [PMID: 26243360 DOI: 10.1007/s00198-015-3256-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 07/20/2015] [Indexed: 01/01/2023]
Abstract
UNLABELLED The relationship between periarticular osteoporosis in the distal forearm and joint destruction or functional impairment in patients with rheumatoid arthritis (RA) is not sufficiently elucidated. From a single institutional cohort study, we found a strong correlation between periarticular forearm bone mineral density (BMD) and joint destruction or functional impairment. INTRODUCTION This study was conducted to investigate (1) the difference between various periarticular regions of interest (ROIs) of BMD of the forearm, (2) the correlation between periarticular forearm BMD and joint destruction and physical function, (3) the independent variables for predicting BMD of the forearm, and (4) the forearm BMD of different ROIs in the early stage of RA. METHODS We conducted a cross-sectional study in an RA cohort. Measurements included BMD of the distal forearm, joint destruction of the hands assessed by modified total Sharp score (mTSS), functional impairment assessed by a health assessment questionnaire (HAQ), and other clinical data. Variables affecting the forearm BMD values were analyzed by correlation and stepwise regression analyses. RESULTS Of the 405 patients enrolled in the present study, 370 (average age; 62.9 years) were identified as having definite RA with a complete set of data. BMD in the distal end of the forearm (BMDud) was significantly reduced compared with that in the distal third of the forearm (BMD1/3). In a stepwise regression analysis, the mTSS in BMD1/3 was an independent predicting variable, while age and partial HAQ scores associated with the upper extremity were common independent variables in BMDud and BMD1/3. BMDud was significantly less than BMD1/3, even in patients with a short duration of the disease. BMD1/3 was significantly less in non-remission group compared with that in remission group in patients with a short duration of the disease. CONCLUSION Periarticular BMD in the distal forearm is closely correlated with joint destruction and functional impairment in RA. Periarticular BMD in the distal forearm may be already reduced at the clinical manifestation of the disease.
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Affiliation(s)
- T Iwata
- Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan
| | - H Ito
- Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan.
| | - M Furu
- Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan
- Department of the Control for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - M Hashimoto
- Department of the Control for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - T Fujii
- Department of the Control for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - M Ishikawa
- Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan
- Department of the Control for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - N Yamakawa
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - C Terao
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - M Azukizawa
- Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan
| | - Y Hamamoto
- Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan
| | - T Mimori
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - H Akiyama
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - S Matsuda
- Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan
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Kilic G, Ozgocmen S. Hand bone mass in rheumatoid arthritis: A review of the literature. World J Orthop 2015; 6:106-116. [PMID: 25621215 PMCID: PMC4303779 DOI: 10.5312/wjo.v6.i1.106] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 04/12/2014] [Accepted: 07/29/2014] [Indexed: 02/06/2023] Open
Abstract
Rheumatoid arthritis (RA) is a common chronic inflammatory disease and periarticular osteoporosis or osteopenia of the inflamed hand joints is an early feature of RA. Quantitative measurement of hand bone loss may be an outcome measure for the detection of joint destruction and disease progression in early RA. This systematic review examines the published literature reporting hand bone mass in patients with RA, particularly those using the dual X-ray absorptiometry (DXA) methods. The majority of the studies reported that hand bone loss is associated with disease activity, functional status and radiological progression in early RA. Quantitative measurement of hand bone mineral density by DXA may be a useful and practical outcome measure in RA and may be predictive for radiographic progression or functional status in patients with early RA.
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Feehan L, Buie H, Li L, McKay H. A customized protocol to assess bone quality in the metacarpal head, metacarpal shaft and distal radius: a high resolution peripheral quantitative computed tomography precision study. BMC Musculoskelet Disord 2013; 14:367. [PMID: 24364867 PMCID: PMC3877978 DOI: 10.1186/1471-2474-14-367] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 12/18/2013] [Indexed: 12/17/2022] Open
Abstract
Background High Resolution-Peripheral Quantitative Computed Tomography (HR-pQCT) is an emerging technology for evaluation of bone quality in Rheumatoid Arthritis (RA). However, there are limitations with standard HR-pQCT imaging protocols for examination of regions of bone commonly affected in RA. We developed a customized protocol for evaluation of volumetric bone mineral density (vBMD) and microstructure at the metacarpal head (MH), metacarpal shaft (MS) and ultra-ultra-distal (UUD) radius; three sites commonly affected in RA. The purpose was to evaluate short-term measurement precision for bone density and microstructure at these sites. Methods 12 non-RA participants, individuals likely to have no pre-existing bone damage, consented to participate [8 females, aged 23 to 71 y [median (IQR): 44 (28) y]. The custom protocol includes more comfortable/stable positioning and adapted cortical segmentation and direct transformation analysis methods. Dominant arm MH, MS and UUD radius scans were completed on day one; repeated twice (with repositioning) three to seven days later. Short-term precision for repeated measures was explored using intraclass correlational coefficient (ICC), mean coefficient of variation (CV%), root mean square coefficient of variation (RMSCV%) and least significant change (LSC%95). Results Bone density and microstructure precision was excellent: ICCs varied from 0.88 (MH2 trabecular number) to .99 (MS3 polar moment of inertia); CV% varied from < 1 (MS2 vBMD) to 6 (MS3 marrow space diameter); RMSCV% varied from < 1 (MH2 full bone vBMD) to 7 (MS3 marrow space diameter); and LSC% 95varied from 2 (MS2 full bone vBMD to 21 (MS3 marrow space diameter). Cortical porosity measures were the exception; RMSCV% varying from 19 (MS3) to 42 (UUD). No scans were stopped for discomfort. 5% (5/104) were repeated due to motion during imaging. 8% (8/104) of final images had motion artifact graded > 3 on 5 point scale. Conclusion In our facility, this custom protocol extends the potential for in vivo HR-pQCT imaging to assess, with high precision, regional differences in bone quality at three sites commonly affected in RA. Our methods are easy to adopt and we recommend other users of HR-pQCT consider this protocol for further evaluations of its precision and feasibility in their imaging facilities.
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Affiliation(s)
- Lynne Feehan
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC, Canada.
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Moon SJ, Ahn IE, Kwok SK, Park KS, Min JK, Park SH, Kim HY, Ju JH. Periarticular osteoporosis is a prominent feature in early rheumatoid arthritis: estimation using shaft to periarticular bone mineral density ratio. J Korean Med Sci 2013; 28:287-94. [PMID: 23399828 PMCID: PMC3565142 DOI: 10.3346/jkms.2013.28.2.287] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 12/17/2012] [Indexed: 12/14/2022] Open
Abstract
We aimed to quantify periarticular osteoporosis and investigate its significance in 45 patients with rheumatoid arthritis (RA) and 106 controls. Dual-energy X-ray absorptiometry (DXA) was used to determine the ratio of shaft to periarticular bone mineral density (BMD) as an index of periarticular demineralization. Periarticular osteoporosis was measured by conventional radiography. The BMDs of shaft and periarticular regions in eight designated areas on proximal phalanges were quantified. Clinical variables were examined to identify risk factors for periarticular osteoporosis. The assessment of periarticular osteoporosis on X-ray images reached a moderate degree of interobserver agreement among four physicians (ĸ = 0.47). For BMD quantification, we designed three types of mathematical formulae: the ratio of shaft to periarticular BMD, the mean of the ratios, and the ratio of the sums. These ratios were significantly higher in the patients with early RA (disease duration ≤ 3 yr) than in controls (P < 0.01). The findings were not as distinctive in patients with established RA. Body mass index, cumulative dose of corticosteroid, and C-terminal telopeptide were correlated with BMD ratios. Conclusively, DXA-assisted localized quantification and BMD ratio calculations are feasible for assessing periarticular demineralization. Periarticular osteoporosis is a relatively distinctive feature of early RA.
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Affiliation(s)
- Su-Jin Moon
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Inhye E. Ahn
- Department of Internal Medicine, The Methodist Hospital, Houston, TX, USA
| | - Seung-Ki Kwok
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung-Su Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun-Ki Min
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ho-Youn Kim
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Hyeon Ju
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Alves C, Luime JJ, Colin EM. Comment on: Periarticular osteoporosis: a useful feature in the diagnosis of early rheumatoid arthritis? Reliablity and validity in a cross-sectional diagnostic study using dual-energy X-ray absorptiometry: Reply. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/kes081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Rothschild B. Comment on: periarticular osteoporosis: a useful feature in the diagnosis of early rheumatoid arthritis? Reliability and validity in a cross-sectional diagnostic study using dual-energy X-ray absorptiometry. Rheumatology (Oxford) 2012; 51:1340-1; author reply 1341. [PMID: 22457436 DOI: 10.1093/rheumatology/kes044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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