Background/Purpose:

To investigate the long-term change in bone mineral density (BMD) in patients with rheumatoid arthritis (RA).

Methods:

In a longitudinal study of 40 patients with RA, we collected clinical data and measured hip BMD by dual-energy X-ray absorptiometry at baseline and after at least 10 years. BMD of the total hip was measured as the percentage of young adult mean (YAM). We compared clinical characteristics between patients with osteopenia (BMD < 80% of YAM) and those without (normal group; BMD ³ 80% of YAM) at baseline. We also analyzed factors associated with a decrease in YAM of >5% during the follow-up period using multivariate logistic regression analysis.

Results:

The mean patient age was 59.8 years, the mean disease duration was 11.5 years, and the mean follow-up period was 10.4 years. Most of the patients (90%) were women. At baseline, 22 patients (55%) were being treated with methotrexate (MTX, mean dose 5.4 mg/week), 26 patients (65%) with prednisolone (PSL, mean dose 6.7 mg/day), and one patient (2.5%) with a biologic disease-modifying antirheumatic drug (DMARD). The antiresorptive drug intervention rate at baseline was 20%. The mean serum C-reactive protein (CRP) and matrix metalloproteinase-3 (MMP-3) values at baseline were 2.21 mg/dL and 258.6 ng/mL, respectively. At follow-up, the mean dose of MTX had increased to 7.0 mg/week and the mean PSL dose had decreased to 2.9 mg/day. The antiresorptive drug intervention rate had increased to 77.5%, and treatment with biologic DMARDs had also increased to 55%. The mean CRP and MMP-3 values had decreased to 0.33 mg/dL and 105.4 ng/ml, respectively. Total hip BMD had decreased from 80.0% YAM at baseline to 76.8% YAM at follow-up. At baseline, 19 patients (47.5%) were classified as osteopenia (BMD < 80% of YAM). The total hip BMD in this group increased slightly from 67.2% YAM at baseline to 69.7% YAM at follow-up. By contrast, the normal group showed a significant decrease in BMD from 91.6% YAM at baseline to 83.1% YAM at follow-up. At both baseline and follow-up, the antiresorptive drug intervention rate was significantly higher in the osteopenia group than in the normal group. No significant differences were found in age, disease activity, use of MTX, PSL, or biological DMARDs between the osteopenia and normal groups. Multivariate logistic regression analysis was used to determine individual factors associated with a reduction in BMD (>5% decrease of YAM). Current use of antiresorptive drugs was strongly associated with a decreased risk for total hip bone loss (odds ratio: 0.04, 95% confidence intervals: 0.003–0.436, P = 0.009)

Conclusion:

Our findings suggest that osteoporosis treatment and tight control of RA disease activity are important for maintaining total hip BMD over a 10-year period. Even RA patients without osteopenia should be started on osteoporosis treatment to inhibit the progression of bone loss.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/change-in-bone-mineral-density-in-patients-with-rheumatoid-arthritis-minimal-10-year-follow-up/