Abnormal bone geometry at the metacarpal bone shaft of rheumatoid arthritis patients with maintained muscle–bone relationship

Eser, Prisca; Aeberli, Daniel; Widmer, Jean; Möller, Burkhard; Villiger, Peter M.

doi:10.1002/acr.20394

Cited by 10 publications

(9 citation statements)

References 39 publications

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“…Despite these challenges, digital X-ray radiogrammetry is a fast, highly reliable and informative method to assess the impact of cortical osteolysis of the metatarsals that occurs in individuals with metabolic and arthritic bone diseases. (14,24) In summary, our results show an accelerated cortical osteolysis in feet of individuals with DM, PN, and CN compared with older adults. These changes arise from increases in diaphysis diameters with decreases in cortical geometry (combined or single wall width and area), resulting in significant increases in BR at the distal, middle, and proximal diaphysis of the second and fifth metatarsals in participants with DMPN&CN.…”

Section: Discussionmentioning

confidence: 51%

“…There have been previous studies of human metacarpals and metatarsals using radiogrammetry to demonstrate cortical osteolysis in rheumatoid arthritis and after hallux valgus correction, respectively, but our study represents the first study of cortical osteolysis of metatarsals in participants with DMPN&CN. Our findings confirm the results of several studies, namely that aging results in the loss of cortical bone (eg, a reduced CCt.Wi and %Ct.Ar) that affects metatarsal strength estimates .…”

Section: Discussionmentioning

confidence: 80%

“…Periosteal edge defects (eg, holes or nonmineralized callus) reduce the true mineralized cortical thickness and decrease the cortical area with a resultant increase in the BR (ie, increasing the risk of metatarsal fracture). Despite these challenges, digital X‐ray radiogrammetry is a fast, highly reliable and informative method to assess the impact of cortical osteolysis of the metatarsals that occurs in individuals with metabolic and arthritic bone diseases …”

Section: Discussionmentioning

confidence: 99%

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Accelerated Cortical Osteolysis of Metatarsals in Charcot Neuroarthropathy: A Cross‐Sectional Observational Study

et al. 2019

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Metatarsals are frequent sites of stress and fragility fractures in younger athletic populations and aging older adults. Metatarsal fractures are particularly common in Charcot neuroarthropathy (CN), a complication of diabetes mellitus (DM) and peripheral neuropathy (PN). Neuropathic metatarsal fractures may be caused by an accelerated cortical bone osteolysis and may be reflected as geometric‐derived strength estimates from standard foot radiographs. The purpose of this cross‐sectional study was to determine geometry and strength‐derived estimates of the metatarsals in individuals with DM, PN, and CN compared with younger and older adult controls who were nondiabetic and nonneuropathic. We studied 62 participants: 20 young adult controls (YACs), 22 older adult controls (OACs), and 20 diagnosed with DMPN&CN. From weight‐bearing radiographs, we measured the outer diaphysis diameter and inner marrow diameter at the distal, middle, and proximal diaphysis sites of the second and fifth metatarsal. From these diameters, we derived strength estimates of combined cortical width (CCt.Wi), percent cortical area (%Ct.rA), buckling ratio (BR), moment of inertia (MOI), and section modulus (SM) at each site in both metatarsals. DMPN&CN participants had an accelerated cortical thinning, decreased %Ct.Ar, increased BR, and lower MOI and SM compared with OACs and YACs. The OACs showed age‐related decreases in CCt.Wi and % Ct.Ar, and increased BR. The BR demonstrated significant group × bone × site interaction with the distal fifth metatarsal in the DMPN&CN group having the lowest bone strength. The BR in the distal fifth metatarsal of DMPN&CN participants was 36% and 49% greater than in the OAC and YAC groups, respectively. DMPN&CN participants have lower metatarsal bone strength estimates compared with younger and older adult controls. Standard foot radiographs demonstrate an accelerated cortical osteolysis in DMPN&CN individuals, particularly in the distal fifth metatarsal diaphysis. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

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Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

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Accelerated Cortical Osteolysis of Metatarsals in Charcot Neuroarthropathy: A Cross‐Sectional Observational Study

et al. 2019

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“…Also cortical BMD was found to be smaller in the RA group due to the thinner cortices. Eser et al 38 described in their study that the bone geometry of the metacarpal shaft was altered in RA patients compared to the healthy controls. They found a significant interaction between RA status, age and cortical thickness.…”

Section: Discussionmentioning

confidence: 99%

Computer‐based measurements of joint space analysis using metacarpal morphometry in hand radiograph for evaluation of rheumatoid arthritis

Snekhalatha

Anburajan

2015

Int J of Rheum Dis

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“…To our knowledge, this is the first prospective cross-sectional study comparing femoral bone geometry in postmenopausal RA patients treated with BP and BP-naïve postmenopausal RA patients. So far, only a few studies have investigated bone shaft geometry in RA patients [ 2 , 6 , 12 , 27 – 29 ]. Recently, in a prospective study, we evaluated bone geometry and density at the third metacarpal bone, the tibia and the radius by means of pQCT scans.…”

Section: Discussionmentioning

confidence: 99%

Influence of bisphosphonate therapy on bone geometry, volumetric bone density and bone strength of femoral shaft in postmenopausal women with rheumatoid arthritis

Meinen

Galli-Lysak

Villiger

et al. 2016

BMC Musculoskelet Disord

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BackgroundThere is evidence that postmenopausal women with rheumatoid arthritis (RA) on glucocorticoid (GC) therapy and bisphosphonate (BP) have an increased risk for atypical subtrochanteric and atypical diaphyseal femoral fracture (AFF). The underlying mechanism has not been elucidated so far. Using peripheral quantitative computed tomography (pQCT), the aim of the present study was to compare bone geometry, volumetric bone mineral density (vBMD) and bone strength of femoral shaft in BP-treated and BP-naïve postmenopausal women with RA.MethodsProspective cross-sectional pQCT scans were taken at 33 % of total femur of BP-treated and BP-naïve RA patients. Bone parameters of the two groups were compared and correlated to disease characteristics and muscle cross-sectional area (CSA).ResultsA total of 60 consecutive postmenopausal RA patients, 20 with BP therapy and 40 BP-naïve, were included in the study. The median age of the subjects was 63.5 years (range 48–85 years), and median disease duration (RA) was 12.0 years (range 2–47 years). Height and weight of the patients of the two groups were comparable. Women in the BP group were on average 4.3 years older (p = 0.044), and duration since menopause was on average 5.76 years longer (p = 0.045). In the BP group, there was a 13.31 % reduced muscle cross-sectional area around the proximal thigh (p = 0.013); cortical CSA was smaller by 5.3 % (p = 0.043); however, total and medullary CSA, as well as cortical vBMD and the polar bone stress–strain index of the femoral shaft were similar in the two groups. In regression analysis, age, time since menopause and muscular CSA were significant factors determining cortical CSA, cortical thickness and femoral index (p < 0.05). Regression model showed no significant effect of BP therapy on bone geometry and density of the femoral diaphysis at 33 %.ConclusionDifferences in cortical CSA between BP-treated and BP-naïve postmenopausal RA patients were found to be associated only with differences in age, time since menopause and muscle cross-sectional area around the proximal thigh. In interpreting our results, it should be kept in mind that BP was given only to patients with increased fracture risk. This fact might have a confounding effect on our findings of differences between the two groups.

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Abnormal bone geometry at the metacarpal bone shaft of rheumatoid arthritis patients with maintained muscle–bone relationship

Cited by 10 publications

References 39 publications

Accelerated Cortical Osteolysis of Metatarsals in Charcot Neuroarthropathy: A Cross‐Sectional Observational Study

Accelerated Cortical Osteolysis of Metatarsals in Charcot Neuroarthropathy: A Cross‐Sectional Observational Study

Computer‐based measurements of joint space analysis using metacarpal morphometry in hand radiograph for evaluation of rheumatoid arthritis

Influence of bisphosphonate therapy on bone geometry, volumetric bone density and bone strength of femoral shaft in postmenopausal women with rheumatoid arthritis

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