Reduced trabecular bone mineral density and cortical thickness accompanied by increased outer bone circumference in metacarpal bone of rheumatoid arthritis patients: a cross-sectional study

Abstract

IntroductionThe objective of this study was to assess three-dimensional bone geometry and density at the epiphysis and shaft of the third meta-carpal bone of rheumatoid arthritis (RA) patients in comparison to healthy controls with the novel method of peripheral quantitative computed tomography (pQCT).MethodsPQCT scans were performed in 50 female RA patients and 100 healthy female controls at the distal epiphyses and shafts of the third metacarpal bone, the radius and the tibia. Reproducibility was determined by coefficient of varia-tion. Bone densitometric and geometric parameters were compared between the two groups and correlated to disease characteristics.ResultsReproducibility of different pQCT parameters was between 0.7% and 2.5%. RA patients had 12% to 19% lower trabecular bone mineral density (BMD) (P ≤ 0.001) at the distal epiphyses of radius, tibia and metacarpal bone. At the shafts of these bones RA patients had 7% to 16% thinner cortices (P ≤ 0.03). Total cross-sectional area (CSA) at the metacarpal bone shaft of pa-tients was larger (between 5% and 7%, P < 0.02), and relative cortical area was reduced by 13%. Erosiveness by Ratingen score correlated negatively with tra-becular and total BMD at the epiphyses and shaft cortical thickness of all measured bones (P < 0.04).ConclusionsReduced trabecular BMD and thinner cortices at peripheral bones, and a greater bone shaft diameter at the metacarpal bone suggest RA spe-cific bone alterations. The proposed pQCT protocol is reliable and allows measuring juxta-articular trabecular BMD and shaft geometry at the metacarpal bone.

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

“…This protocol allows accurate measurements of volumetric BMD and cross-sectional geometry at the distal epiphysis and shaft of the third metacarpal bone. At the radius, the tibia, and the third metacarpal bone, we have found epiphyseal trabecular BMD and shaft cortical thickness to be reduced in female RA patients compared to healthy controls (13). While existing studies have shown that bone mass at the metacarpal bone shaft of RA patients is reduced (15), and its cross-sectional geometry different from healthy controls (13), it has not been assessed whether these differences may be due to the Metacarpal bone measurements.…”

Structural Bone Deficits in HIV/HCV-Coinfected, HCV-Monoinfected, and HIV-Monoinfected Women

“…Studies of patients with other chronic inflammatory conditions, particularly inflammatory bowel disease [20,21] and rheumatoid arthritis [22], have demonstrated a similar pattern of trabecular bone loss and endocortical thinning. The higher levels of TNF-α among coinfected participants further suggests the contribution of chronic inflammation.…”

“…Our analyses focused on women because associations between HIV/HCV coinfection and low BMD have been stronger in women than in men [12,14]. We hypothesized that coinfected women would have lower trabecular volumetric BMD and cortical thinning due to endocortical bone loss, a pattern observed in other chronic inflammatory diseases [20][21][22], compared with HCV-or HIV-monoinfected women and those without a history of either infection.…”

Potential Sources of Quantification Error When Retrospectively Assessing Metacarpal Bone Loss From Historical Radiographs by Using Digital X-ray Radiogrammetry: An Experimental Study

“…Their coefficient of variation (CV%) of about 0.4% (8,9) compares favorably with the approximately 0.9% of dual energy X-ray absorptiometry (DXA) of the hand (10), the 0.7% of computed tomography (CT) (11) and the 1-3% of DXA hip (12). The high reproducibility of DXR makes it suitable for evaluating treatment effect, because very small changes in BMD can be detected with a high statistical power.…”