title: Post-menopausal women with rheumatoid arthritis who are treated with raloxifene or alendronate or glucocorticoids have lower serum undercarboxylated osteocalcin levels.
abstract: BACKGROUND
  Serum undercarboxylated osteocalcin (ucOC) is a biochemical bone marker of vitamin K insufficiency. It had been reported that bone resorption inhibitors tend to decrease the serum ucOC level in patients with primary osteoporosis. In rheumatoid arthritis (RA) patients, these results have never been reported.
  
  
  OBJECTIVE
  We investigated risk factors which could change serum ucOC level in post-menopausal women with RA (no.=100).
  
  
  METHODS
  Twenty patients received no bone resorption inhibitor (control), 30 received raloxifene (RLX), while 50 received alendronate (ALN). This cross-sectional study was limited to patients with low RA disease activity (Disease Activity Score-28 ≤3.2). We measured serum ucOC, and the data were analyzed by multivariable analysis, including ucOC and the other variables.
  
  
  RESULTS
  Scheffe's F test demonstrated a significant difference in serum ucOC levels between controls and the RLX group (p<0.01), and between controls and the ALN group (p<0.01). Serum ucOC levels were low in both treated groups. An adjusted multivariate analysis was performed for the variables: bone resorption inhibitor use, serum alkaline phosphatase, glucocorticoid dose, age, estimated glomerular filtration rate and matrix metalloproteinase 3. As a result, serum ucOC inversely correlated with bone resorption inhibitor use (p<0.01) and oral glucocorticoid dose (p<0.01), which were independent risk factors of lowering ucOC.
  
  
  CONCLUSIONS
  Bone resorption inhibitors and glucocorticoids were independent risk factors for lowering serum ucOC levels in post-menopausal RA patients.
authors.affiliation: Department of Internal Medicine, Center for Rheumatic Diseases, Dohgo Spa Hospital, 21-21 Otsu Dohgo-Himezuka, Matsuyama, Ehime, 790-0858, Japan. bachblau_since2001@yahoo.co.jp
authors.forename: S
authors.initials: S
authors.lastname: Mokuda
authors.forename: Y
authors.initials: Y
authors.lastname: Okuda
authors.forename: M
authors.initials: M
authors.lastname: Onishi
authors.forename: N
authors.initials: N
authors.lastname: Sawada
authors.forename: K
authors.initials: K
authors.lastname: Matoba
authors.forename: A
authors.initials: A
authors.lastname: Yamada
authors.forename: K
authors.initials: K
authors.lastname: Jouyama
authors.forename: K
authors.initials: K
authors.lastname: Takasugi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019386:Alendronate / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D050071:Bone Density Conservation Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001842:Bone and Bones / Q000187:drug effects / Q000378:metabolism; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D015675:Osteocalcin / Q000097:blood* / Q000378:metabolism; D015663:Osteoporosis, Postmenopausal / Q000097:blood / Q000209:etiology; D017698:Postmenopause; D020849:Raloxifene Hydrochloride / Q000009:adverse effects* / Q000627:therapeutic use; D012307:Risk Factors; D012720:Severity of Illness Index; D014813:Vitamin K Deficiency / Q000097:blood / Q000139:chemically induced* / Q000503:physiopathology
chemical_list: D015415:Biomarkers; D050071:Bone Density Conservation Agents; D005938:Glucocorticoids; D015675:Osteocalcin; D020849:Raloxifene Hydrochloride; D019386:Alendronate