Background/Purpose: Osteoporosis (OP) is a frequently underestimated comorbidity in immune-mediated inflammatory diseases (IMIDs). Its association with IMIDs is worse characterized in Psoriatic Arthritis (PsA) than in rheumatoid arthritis (RA). The objective of the study was determine the densitometric values in lumbar spine (LS) and femoral neck (FN) of our cohort of PsA patients to estimate the frequency of OP and analyze the factors associated with a lower bone mineral density (BMD).

Methods: Cross-sectional study in patients (pts) with PsA from a monographic consultation of recent-onset PsA who were invited to perform a DXA densitometry (GELunar Prodigy®). SPSS25 was used for statistical analysis.

Results: 155 PsA pts was screened with DXA. Osteopenia was observed in 84/155 (54.2%) pts: femoral neck (FN) in 74/155 (47,7%) pts and lumbar spine (LS) in 51/152 (33,5%) pts (3 pts could not have lumbar spine determination by previous surgery). OP was observed in 19 (12.3%) pts: LS in 11/152 (7.2%), and FN in 11/155 (7.1%) pts. The mean (SD) age at DXA was 47.1 (12.9) years (y). The mean evolution time was 10.2y (6.2) from diagnosis to DXA; median 9y (6;13). OP, in general, and FN OP, were associated with age, but not with the average evolution time of PsA: OP 55.3y (10.0) vs 45.9y (12.8) (p=0.003) and NF OP 58.5y (10.2) vs 46.2y (12.7), (p=0.002). LS OP was not associated with any of the parameters studied. LS osteopenia was more frequent in women 32/76 (42.1%) than men 19/76 (25%) [OR 1,515 (1,020;2,249); p=0.026]. Hyperuricemic pts were less likely to have vertebral osteopenia (OR 2.525 (1.027;6.205) than non-hyperuricemic. Inflammatory bowel disease (IBD) was associated with LS osteopenia [OR 8.511 (0.926;78.247), p=0.044]. FN OP was more frequent in males 9/79 (11.4%) than females 2/76 (2.6%) OR=4.75 (0.99; 22.8) p(fisher)=0.057. We found association of FN OP with axial involvement [OR 3.882 (1.115;13.518); p=0.024], hypertension [OR 9,9 (2,055;47,689); p< 0.001], ischemic heart disease (IHD) [OR 7.657 (1.914;30.630), p< 0.001] and vitamin D deficiency (< 20ng/dl) [26/75 (16,8%) pts; OR 8.727 (0.921;82.691), p=0.046, but not with the rest of the PsA domains, comorbidities or cardiovascular risk factors (CVRF). Femoral osteopenia was only associated with hypertension but more weakly than FN OP. We found no association between the presence of OP and current or previous treatments. Pts who received DMARDs had a lower tendency to present osteopenia [OR 3.28 (0.98; 10.96), p=0.04]. Forty-three pts had received steroids, 141 DMARDs, 129 conventional syinthetic-DMARDs (122 methotrexate), 69 biological-DMARDs with a total of 119 cycles (mainly, TNFi) and 20 targeted synthetic-DMARDs. In the multivariate analysis, we found a positive correlation with OP and IHD (OR= 2.08; 0.42) as in femoral OP (OR=3.17; 0.002), and negative with hyperuricemia (p=0.002). Osteopenia is associated with age (OR=2.64; 0.01), axial involvement and time of disease evolution (not significant).

Conclusion: In our cohort, OP is more frequent in men, it is associated with age despite the time of evolution of the disease. Femoral OP is more frequent in patients with axial involvement, hypertension, heart ischemic disease and vitamin D deficiency.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/osteoporosis-in-psoriatic-arthritis-2/