Bone loss in unclassified polyarthritis and early rheumatoid arthritis is better detected by digital x ray radiogrammetry than dual x ray absorptiometry: relationship with disease activity and radiographic outcome

Jensen, Teis; Klarlund, Mette; Hansen, Michael; Jensen, Karl Erik; Pødenphant, Jan; Hansen, Troels Mørk; Skjødt, Henrik; Hyldstrup, Lars

doi:10.1136/ard.2003.013888

Cited by 70 publications

(58 citation statements)

References 28 publications

(28 reference statements)

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“…Therefore, high disease activity could contribute to bone loss through 2 pathways. Moreover, BMD decreases more rapidly in active disease than in inactive disease (20,21). This implies that the extent of BMD loss might be different for patients with different levels of disease activity.…”

Section: Introductionmentioning

confidence: 99%

Changes in hand bone mineral density and the association with the level of disease activity in patients with rheumatoid arthritis: Bone mineral density measurements in a multicenter randomized clinical trial

Dirven

Güler‐Yüksel

Beus

et al. 2011

Arthritis Care & Research

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Objective. To determine if metacarpal bone mineral density (mBMD) gain occurs in patients with rheumatoid arthritis (RA). If mBMD loss is driven by inflammation, we expect to find mBMD gain in patients who are in remission. Methods. mBMD was measured by digital x-ray radiogrammetry in consecutive radiographs of 145 patients with RA with either continuous high disease activity (HDA; Disease Activity Score [DAS] >2.4), low disease activity (LDA; 1.6 > DAS < 2.4), or continuous clinical remission (CR; DAS <1.6) during a 1-year observation period. The association of mBMD changes with disease activity was investigated with multinomial regression analysis. Next, clinical variables associated with mBMD gain were identified. Results. Mean change in mBMD in CR patients was ؊0.03%, compared to ؊3.13% and ؊2.03% in HDA and LDA patients, respectively (overall, P < 0.001). Of the patients in CR, 32% had mBMD loss (less than or equal to ؊4.6 mg/cm 2 /year), compared to 62% and 66% of the patients with HDA or LDA, respectively, whereas 26% of the patients in CR had mBMD gain (>4.6 mg/cm 2 /year), compared to 2% of the patients with HDA and 5% of the patients with LDA. Patients in CR had a higher chance of having mBMD gain, compared with LDA and HDA (relative risk [RR] 14.9, 95% confidence interval [95% CI] 3.0 -18.7 and RR 4.7, 95% CI 1.2-6.3, respectively). CR, hormone replacement therapy, and lower age were significant independent predictors of mBMD gain. Conclusion. In RA, mBMD gain occurs primarily in patients in continuous (>1 year) CR and rarely in patients with continuous HDA or LDA. This suggests that mBMD loss is driven by inflammation.

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Section: Introductionmentioning

confidence: 99%

Changes in hand bone mineral density and the association with the level of disease activity in patients with rheumatoid arthritis: Bone mineral density measurements in a multicenter randomized clinical trial

Dirven

Güler‐Yüksel

Beus

et al. 2011

Arthritis Care & Research

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“…Kalla et al reported in 1991 that cortical thickness measured in digitized images declined significantly in a period when RA patients were not receiving disease-modifying antirheumatic drugs and then stabilized with treatment (14). Subsequently, multiple studies demonstrated that loss of metacarpal shaft cortical thickness occurs in parallel with increasing radiographic scores (6,15). In other studies, cortical thinning has been reported to parallel progression of erosion scores; one longitudinal study reported by Hoff and colleagues in 2009 showed that cortical thinning of the hand detected early in the disease predicts progression of erosive disease 5 and 10 years later (9).…”

Section: Introductionmentioning

confidence: 99%

Denosumab prevents metacarpal shaft cortical bone loss in patients with erosive rheumatoid arthritis

Sharp¹,

Tsuji²,

Ory³

et al. 2010

Arthritis Care & Research

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Objective. Osteoclast-mediated bone loss in the hand predicts future bone erosions in patients with rheumatoid arthritis (RA). Osteoclast activity depends on RANKL, which is inhibited by denosumab, an investigational fully human monoclonal antibody against RANKL. We measured metacarpal shaft cortical bone thickness using a novel computer-based technique, digital x-ray radiogrammetry (DXR), to evaluate the effects of denosumab on cortical bone in RA. Methods. Patients (n ‫؍‬ 227) with active, erosive RA were randomized to receive subcutaneous denosumab 60 mg or 180 mg or placebo every 6 months. All patients received stable doses of methotrexate and daily calcium and vitamin D. For this blinded post hoc analysis (n ‫؍‬ 218), cortical bone loss was determined by DXR using computer-assisted measurement of cortical thickness and shaft width at 21 midshaft levels of the second through fourth metacarpal bones of both hands. Results. At 12 months, patients receiving denosumab had significantly less metacarpal bone loss versus placebo (denosumab 60 mg: ؊0.0034, denosumab 180 mg: 0.0001 gain, placebo: ؊0.0108; P < 0.01 for both denosumab doses). Twelve-month decreases from baseline greater than the smallest detectable change occurred in 2 patients in the denosumab 180 mg group, 9 patients in the denosumab 60 mg group, and 12 patients in the placebo group. Negative correlation was significant between static cortical thickness ratios and static erosion scores (6 and 12 months), and for placebo, between changes in erosion scores and changes in cortical thickness ratio. Conclusion. Twice-yearly injections of denosumab with ongoing methotrexate treatment significantly reduced cortical bone loss in RA patients for up to 12 months. These results add to the growing evidence supporting the clinical utility of DXR.

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“…Further studies are needed to investigate SDs from the reference population to obtain objective and accurate results in T and Z scores for the hand [18] . Several studies support that hand bone loss occurs early in the disease process and more rapidly than at the hip and spine [4,10,23,24,26,34] . Ten studies demonstrated that hand bone loss was higher in patients with RA than matched healthy controls and patients with other rheumatic diseases [13][14][15][16][17][18][19][20][21][22] .…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, five longitudinal studies reported hand bone loss was higher in patients with RA than in matched healthy controls or patients with other rheumatic diseases, including spondyloarthropathies or [7] CS RA: 100 F 53. In the IFX treated group hand bone loss arrested at the hip but not at the hand and lumbar spine undifferentiated arthritis [4,10,[23][24][25] .…”

Section: Researchmentioning

confidence: 99%

“…Five longitudinal studies reported that hand bone loss occurred early in the disease duration in patients with RA [4,10,23,24,26] . A 5-year longitudinal study of hand bone mineral content (BMC) in patients with early RA indicated that the rate of hand bone loss measured by DXA was more pronounced in the first years of disease and then slowed.…”

Section: Hand Bone Mass and Disease Durationmentioning

confidence: 99%

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Hand bone mass in rheumatoid arthritis: A review of the literature

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2015

WJO

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Bone loss in unclassified polyarthritis and early rheumatoid arthritis is better detected by digital x ray radiogrammetry than dual x ray absorptiometry: relationship with disease activity and radiographic outcome

Cited by 70 publications

References 28 publications

Changes in hand bone mineral density and the association with the level of disease activity in patients with rheumatoid arthritis: Bone mineral density measurements in a multicenter randomized clinical trial

Changes in hand bone mineral density and the association with the level of disease activity in patients with rheumatoid arthritis: Bone mineral density measurements in a multicenter randomized clinical trial

Denosumab prevents metacarpal shaft cortical bone loss in patients with erosive rheumatoid arthritis

Hand bone mass in rheumatoid arthritis: A review of the literature

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