Effect of Rheumatoid Arthritis on Volumetric Bone Mineral Density and Bone Geometry, Assessed by Peripheral Quantitative Computed Tomography in Postmenopausal Women Treated with Bisphosphonates

Tournis, Symeon; Samdanis, Vasilios; Psarelis, Savvas; Liakou, Chrysoula; Antoniou, Julia D.; Georgoulas, Thomas; Dontas, Ismene; Παπαϊωάννου, Νικόλαος; Gazi, Susan; Lyritis, George P.

doi:10.3899/jrheum.110579

Cited by 9 publications

(7 citation statements)

References 47 publications

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“…Our results are in agreement with those of Tournis et al who evaluated tibial bone geometry in 65 postmenopausal osteoporotic RA patients treated with BP comparing it to that in women with primary osteoporosis [ 12 ]. At 38 % (cortical site), cortical CSA, and thickness were significantly lower in the RA group, whereas vBMD was comparable.…”

Section: Discussionsupporting

confidence: 92%

“…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%

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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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Section: Discussionsupporting

confidence: 92%

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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“…Furthermore, little is known about the influence of conventional DMARDs. Data on MTX are conflicting, and the influence of leflunomide on bone remains unclear . In the present study, current DMARDs intake was associated with an increased cortical perimeter and smaller cortical thickness at the distal radius.…”

Section: Discussionmentioning

confidence: 48%

Decreased Quantity and Quality of the Periarticular and Nonperiarticular Bone in Patients With Rheumatoid Arthritis: A Cross-Sectional HR-pQCT Study

Kocijan

Finzel

Englbrecht

et al. 2013

Journal of Bone and Mineral Research

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Rheumatoid arthritis (RA) is a highly bone destructive disease. Although it is well established that RA leads to bone loss and increased fracture risk, current knowledge on the microstructural changes of bone in RA is still limited. The purpose of this study was to assess the microstructure of periarticular and nonperiarticular bone in female and male RA patients and compare it with respective healthy controls. We performed two high-resolution peripheral quantitative computed tomography (HR-pQCT; Xtreme-CT) scans, one of the distal radius and one of the ultradistal radius in 90 patients with RA (60 females, 30 males) and 70 healthy controls (40 females, 30 males) matched for sex, age, and body mass index. Volumetric bone mineral density (vBMD), bone geometry, and bone microstructure including trabecular bone volume fraction (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb.Th), cortical thickness (Ct.Th) and cortical porosity (Ct.Po) were assessed. At the distal and ultradistal radius, trabecular (p ¼ 0.005 and p < 0.001) and cortical BMD (p < 0.001 and p < 0.001) were significantly decreased in male and female patients with RA, respectively. BV/TV was also decreased at both sites, based on lower Tb.N in female RA (p < 0.001 for both sites) and lower Tb.Th (p ¼ 0.034 and p ¼ 0.005) in male RA patients compared with respective healthy controls. Cortical thinning (p ¼ 0.018 and p ¼ 0.002) but not Ct.Po (p ¼ 0.070 and p ¼ 0.275) was pronounced in male and female RA patients at the distal radius. Cortical perimeter was increased in male and female RA patients at both sites. Multiple regression models showed that bone geometry (cortical perimeter) is predominantly influenced by age of the RA patient, cortical thickness by both age and disease duration, and trabecular microstructure predominantly by the disease duration. In summary, these data show profound deterioration of bone microstructure in the appendicular skeleton of RA patients at both periarticular and nonperiarticular sites.

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“…15 These changes are in accordance with the known reduction in cortical bone mass in RA, which has been documented in several studies in patients with RA and seems to be closely related to disease activity and the development of bone erosions. 26–30 …”

Section: Anatomic Factors and Microstructurementioning

confidence: 99%

Bone erosion in rheumatoid arthritis: mechanisms, diagnosis and treatment

2012

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Bone erosion is a central feature of rheumatoid arthritis and is associated with disease severity and poor functional outcome. Erosion of periarticular cortical bone, the typical feature observed on plain radiographs in patients with rheumatoid arthritis, results from excessive local bone resorption and inadequate bone formation. The main triggers of articular bone erosion are synovitis, including the production of proinflammatory cytokines and receptor activator of nuclear factor κB ligand (RANKL), as well as antibodies directed against citrullinated proteins. Indeed, both cytokines and autoantibodies stimulate the differentiation of bone-resorbing osteoclasts, thereby stimulating local bone resorption. Although current antirheumatic therapy inhibits both bone erosion and inflammation, repair of existing bone lesions, albeit physiologically feasible, occurs rarely. Lack of repair is due, at least in part, to active suppression of bone formation by proinflammatory cytokines. This Review summarizes the substantial progress that has been made in understanding the pathophysiology of bone erosions and discusses the improvements in the diagnosis, monitoring and treatment of such lesions.

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Effect of Rheumatoid Arthritis on Volumetric Bone Mineral Density and Bone Geometry, Assessed by Peripheral Quantitative Computed Tomography in Postmenopausal Women Treated with Bisphosphonates

Cited by 9 publications

References 47 publications

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

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

Decreased Quantity and Quality of the Periarticular and Nonperiarticular Bone in Patients With Rheumatoid Arthritis: A Cross-Sectional HR-pQCT Study

Bone erosion in rheumatoid arthritis: mechanisms, diagnosis and treatment

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