Hand bone loss as an outcome measure in established rheumatoid arthritis: 2-year observational study comparing cortical and total bone loss.
The aim of this 2-year longitudinal observational study was to explore hand bone loss as a disease outcome measure in established rheumatoid arthritis (RA). A cohort of 215 patients with RA (170 women and 45 men, aged 20-70 years) were recruited from the Oslo RA registry and studied for changes in hand bone mass during a 2-year follow-up. Digital X-ray radiogrammetry (DXR) was used to measure cortical hand bone mineral density (BMD) and metacarpal cortical index, whereas dual-energy X-ray absorptiometry (DXA) was used to assess whole hand BMD, which measures total cortical and trabecular bone. DXA-BMD total hip and spine and informative data for disease and therapy were also collected. Hand bone loss could be revealed over a 2-year follow-up measured by DXR-BMD (-0.90%, P < 0.01), but not by DXA-BMD (0.00%, P = 0.87). DXA-BMD hand bone loss was only observed in patients with disease duration < or = 3 years and not in patients with longer disease duration (-0.96% versus 0.24%, P < 0.01), whereas loss of DXR-BMD was independent of disease duration. Disease activity (measured by the disease activity score including 28 joints) independently predicted loss of DXR-BMD but not changes in the DXA-BMD hand in the multivariate analysis. The change in DXR metacarpal cortical index was highly correlated to DXR-BMD (r = 0.94, P < 0.001). These data suggest that DXR-BMD may be a more appropriate technique to identify RA-related bone involvement in hands compared with DXA-BMD measurement, but further studies are needed to explore this hypothesis.
Hoff
Mari
M
Norwegian University of Science and Technology, MTFS, Department of Neuroscience, Division of Rheumatology, NO-7489 Trondheim, Norway. mari.hoff@ntnu.no
Haugeberg
Glenn
G
Kvien
Tore K
TK
D015502:Absorptiometry, Photon / Q000379:methods; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism; D015415:Biomarkers; D015519:Bone Density; D005260:Female; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D050279:Metacarpal Bones / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology*; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism; D012720:Severity of Illness Index; D016896:Treatment Outcome
D015415:Biomarkers
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