title: Generalized bone loss as a predictor of three-year radiographic damage in African American patients with recent-onset rheumatoid arthritis.
abstract: OBJECTIVE
  To examine the association between baseline bone mineral density (BMD) and radiographic damage at 3 years of disease duration in a longitudinal cohort of African Americans with recent-onset rheumatoid arthritis (RA).
  
  
  METHODS
  African American RA patients with a disease duration of <2 years (n = 141) were included in the study. All patients underwent baseline BMD measurements (femoral neck and/or lumbar spine) using dual x-ray absorptiometry. T scores were calculated using normative data from the general population of African Americans. Patients were categorized as having osteopenia/osteoporosis (T score less than or equal to -1) or as being healthy. Hand and wrist radiographs, obtained at baseline and at 3 years of disease duration, were scored using the modified Sharp/van der Heijde method. The association between baseline BMD and total radiographic score at 3 years of disease was examined using multivariable negative binomial regression.
  
  
  RESULTS
  At baseline, the mean age and the mean disease duration were 52.4 years and 14.8 months, respectively; 85.1% of the patients were women. The average total radiographic scores at baseline and at 3 years of disease were 2.4 and 5.7, respectively. In the final reduced multivariable model, adjusting for age, sex, anti-cyclic citrullinated peptide antibody positivity, and the presence of radiographic damage at baseline, the total radiographic score at 3 years disease in patients with osteopenia/osteoporosis of the femoral neck was twice that in patients with normal bone density, and the difference was statistically significant (P = 0.0084). No association between lumbar spine osteopenia/osteoporosis and radiographic score was found.
  
  
  CONCLUSIONS
  Our findings suggest that reduced generalized BMD may be a predictor of future radiographic damage and support the hypothesis that radiographic damage and reduced generalized BMD in RA patients may share a common pathogenic mechanism.
authors.affiliation: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL 35294, USA. jszhang@uab.edu
authors.forename: Jie
authors.initials: J
authors.lastname: Zhang
authors.forename: David T
authors.initials: DT
authors.lastname: Redden
authors.forename: Gerald
authors.initials: G
authors.lastname: McGwin
authors.forename: Leigh F
authors.initials: LF
authors.lastname: Callahan
authors.forename: Edwin A
authors.initials: EA
authors.lastname: Smith
authors.forename: Graciela S
authors.initials: GS
authors.lastname: Alarcón
authors.forename: Larry W
authors.initials: LW
authors.lastname: Moreland
authors.forename: Désirée M
authors.initials: DM
authors.lastname: van der Heijde
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Brown
authors.forename: Donna K
authors.initials: DK
authors.lastname: Arnett
authors.forename: Ted R
authors.initials: TR
authors.lastname: Mikuls
authors.forename: S Louis
authors.initials: SL
authors.lastname: Bridges
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000473:pathology; D015519:Bone Density; D018450:Disease Progression; D005260:Female; D006225:Hand / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000000981:diagnostic imaging* / Q000473:pathology; D011237:Predictive Value of Tests; D011859:Radiography; D012720:Severity of Illness Index; D014955:Wrist Joint / Q000000981:diagnostic imaging* / Q000473:pathology