title: Relationship of focal erosions, bone mineral density, and parathyroid hormone in rheumatoid arthritis.
abstract: OBJECTIVE
  To investigate the relationship among focal bone erosions and bone mineral density (BMD), 25(OH) vitamin D (25OHD), and parathyroid hormone (PTH) values in patients with rheumatoid arthritis (RA).
  
  
  METHODS
  The study included 1191 RA patients (1014 women, 177 men, mean age 58.9 ± 11.1 yrs) participating in a multicenter, cross-sectional study.
  
  
  RESULTS
  Radiographic evidence of typical bony erosions on hands or forefeet was found in 64.1% of patients. In those with bone erosions as compared to those without, mean BMD Z score values were significantly lower at both the spine (-0.74 ± 1.19 vs -0.46 ± 1.31; p = 0.05) and the hip (-0.72 ± 1.07 vs -0.15 ± 1.23; p < 0.001). In the subgroup of patients not taking vitamin D supplements, PTH levels were significantly higher in those with erosive arthritis (25.9 ± 14.0 vs 23.1 ± 11.6 pg/ml; p = 0.01); whereas the 25OHD concentrations were very similar in the 2 groups. The mean differences for BMD and PTH among the erosive and nonerosive RA remained statistically significant when values were simultaneously adjusted for all disease and mineral metabolism factors (i.e., age, sex, menopause, disease duration, Disease Activity Score 28-joint count, Health Assessment Questionnaire, activities of daily living, Steinbrocker functional state, glucocorticoid therapy, body weight, and bisphosphonate treatment).
  
  
  CONCLUSIONS
  Our results suggest that the presence of bone erosions in RA correlates with low BMD levels and high PTH levels, and that these associations are independent of the degree of functional impairment and other common determinants of bone mass and mineral metabolism in adults with RA. These findings suggest that treatments to prevent bone loss or suppress PTH levels might positively affect the progression of bone erosions in RA.
authors: Rheumatology Unit, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126 Verona, Italy. maurizio.rossini@univr.it
authors: Maurizio
authors: M
authors: Rossini
authors: Gianfilippo
authors: G
authors: Bagnato
authors: Bruno
authors: B
authors: Frediani
authors: Annamaria
authors: A
authors: Iagnocco
authors: Giovanni
authors: G
authors: LA Montagna
authors: Giovanni
authors: G
authors: Minisola
authors: Maurizio
authors: M
authors: Caminiti
authors: Massimo
authors: M
authors: Varenna
authors: Silvano
authors: S
authors: Adami
mesh_terms: D015502:Absorptiometry, Photon; D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000473:pathology* / Q000503:physiopathology*; D015519:Bone Density / Q000502:physiology*; D001842:Bone and Bones / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D005260:Female; D033023:Foot Joints / Q000000981:diagnostic imaging / Q000473:pathology; D050823:Hand Joints / Q000000981:diagnostic imaging / Q000473:pathology; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D012720:Severity of Illness Index; D013131:Spine / Q000000981:diagnostic imaging / Q000503:physiopathology; D014807:Vitamin D / Q000097:blood
chemical_list: D010281:Parathyroid Hormone; D014807:Vitamin D