Vitamin D, inflammatory markers, steroid use and systemic factors: which is the culprit in rheumatoid arthritis associated osteoporosis?

Abstract

Aim: To explore the risk factors for osteoporosis in Rheumatoid Arthritis (RA) patients. Methods:A cross-sectional study was conducted on 93 patients meeting the American College of Rheumatology -European League Against Rheumatism classification criteria for RA 2010(ACR-EULAR). Serum 25-OH vitamin D (25(OH) D levels was measured. In addition, the levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), rheumatoid factor (RhF), anticyclic -citrullinated protein/peptide antibodies (Anti-CCP) were assessed. Dual-energy X-ray absorptiometry (DEXA) was also used to measure the bone mineral density BMD of the left femur at the time of recruitment. Results:The RA cohort was predominantly female (88.2%). The average age of the participants was 46.5 ± 15.2 years. Osteoporosis was present in 25 (26.9%). Osteoporotic cases were significantly older (p <0.001), female (p = 0.032) and had significantly more frequencies of diabetes (p = 0.022) and hypertension (p = 0.018) and had significantly lower calcium (p = 0.038). Logistic regression model for factors affecting osteoporosis showed that Steroids intake, increasing age and decreasing serum calcium were factors increasing the likelihood of having osteoporosis. Vitamin D did not show any relation with osteoporosis. Serum inflammatory markers like ESR, CRP, R.F and anti-CCP were higher in osteoporotic group but not significant. Conclusions:The results of this analysis indicated that systemic factors like age and intake of steroids are culprit factors in rheumatoid arthritis associated osteoporosis.