Distinct biomarkers for different bones in osteoporosis with rheumatoid arthritis

Abstract

Background Rheumatoid arthritis (RA) is known to cause secondary osteoporosis and fragility fractures. This study aimed to identify biomarkers predictive of bone mineral density (BMD) change at three anatomical sites in patients with RA. Methods We conducted a prospective longitudinal study in patients with RA. In 2012, we recruited 379 patients from an RA cohort, 329 of whom underwent evaluation of blood and urine biomarkers together with measurement of BMD in the lumbar spine, proximal femur, and distal forearm. The BMD in these three regions was reassessed in 2014. We performed multivariate linear regression analysis to identify those factors associated with BMD change. Results The averages of age, body mass index, and disease activity score in 28 joints (DAS28) at baseline were 63.2 (minimum to maximum, 32–85), 21.3 (12.3–30.0), and 3.2 (0.1–5.9), respectively. Univariate analysis showed that the annual BMD change was significantly associated with the use of steroid, bisphosphonate (BP) or vitamin D (VitD), and serum homocysteine in the lumber spine; DAS28, the use of BP or VitD, CRP, and anti-cyclic citrullinated peptide antibody (ACPA) in the proximal femur; and the dosage of MTX, the use of BP or VitD, and serum tartrate-resistant acid phosphatase 5b (TRACP-5b) in the distal forearm, respectively. Conclusions Predictive biomarkers for BMD change in RA patients differ at each anatomical site. Practitioners should treat each anatomical site with different markers and prescribe osteoporosis drugs to prevent fractures for RA patients.

Total Knee Arthroplasty in Patients with Rheumatoid Arthritis, Severe Osteoporosis, and Genu Valgum

“…Patients with RA often have severe osteoporosis [5,6], which may seriously affect knee functions [7]. TKA might be required [8,9], but studies have yet comprehensively reported the effectiveness of TKA in RA patients with severe osteoporosis and genu valgum.…”

“…Severe osteoporosis is not an absolute contraindication of TKA, but perioperative treatment and preparation are very important. The frequency of osteoporosis is high in patients with RA [5,6], and TKA in such patients can be highly di cult [8,9]. First, improper position, inappropriate traction, and rough operating during TKA could induce bone fracture [8,9,33].…”

“…In addition, patients with RA also generally suffer from severe osteoporosis [5,6], which in turn may lead to severe pain and functional limitation in the knee joint [7], and thus require total knee arthroplasty (TKA) [8,9]. Such patients are generally accompanied by joint deformity, especially genu valgum [10], which could increase the di culties of TKA and increase the risks of developing postoperative complications such as common peroneal nerve injuries and patellar maltracking [8,9].…”

Osteoporosis in Inflammatory Arthritides: New Perspective on Pathogenesis and Treatment

“…The risk of developing OP in RA is correlated with the duration and the severity of the disease ( 19 , 44 ) and even RA pre-menopausal women or men are exposed to a greater risk of osteoporosis in comparison with age- and sex-matched healthy controls ( 45 , 46 ). A prospective longitudinal study on 379 patients identified some biomarkers predictive of BMD change in patients with RA ( 47 ). It was found that the annual BMD change at the lumbar spine had a significant association with glucocorticoids use, bisphosphonate or vitamin D use, and homocysteine.…”

Chronic administration of Cl‐amidine, a pan‐peptidylarginine deiminase inhibitor, does not reverse bone loss in two different murine models of osteoporosis

“…Accordingly, Cheng et al () reported that anti‐CCP positive patients with RA have higher probability of osteoporotic fracture compared to anti‐CCP negative patients with RA. Furthermore, a recently longitudinal cohort study identified distinct effective biomarkers as predictor changes on BMD in different bones in osteoporosis with RA, being ACPA serum levels a significant predictor of BMD changes in the proximal femur (Tomizawa et al, ). Finally, it has been shown that ACPA positive subjects without clinical signs of RA have significantly lower percentages of trabecular bone volume and cortical bone mineral density at the level of the metacarpal heads compared ACPA negative subjects (Kleyer et al, ).…”