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Comparison of peripheral quantitative computed tomography forearm bone density versus DXA in rheumatoid arthritis patients and controls

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Abstract

Summary

Rheumatoid arthritis (RA) has been associated with osteoporosis. Quantitative computed tomography (QCT) is capable of assessing bone density and composition. We found lower bone density in RA compared to controls. Age and RA duration influenced bone density. QCT may be useful to assess bone metabolism in RA.

Introduction

RA is associated with generalized and periarticular osteoporosis. In addition to DXA that determines areal bone mineral density (BMD), peripheral QCT also detects volumetric BMD. QCT differentiates between total, trabecular, and cortical BMD. Here, we compared DXA and QCT in RA patients and healthy controls.

Methods

BMD of 57 female RA patients and 32 age-matched healthy female controls were assessed by DXA. QCT of the forearm ultradistal region was also performed. Densitometry data were correlated with age, disease duration, disease activity, serum CRP, and anti-CCP levels.

Results

Total bone density (310.4 ± 79.7 versus 354.0 ± 54.1 mg/cm3; p = 0.007) and attenuation (0.37 ± 0.05 versus 0.40 ± 0.03 1/cm; p = 0.001), trabecular density (157.6 ± 57.0 versus 193.8 ± 48.7 mg/cm3; p = 0.005) and attenuation (0.28 ± 0.03 versus 0.32 ± 0.04 1/cm; p < 0.0001), and cortical density (434.3 ± 115.8 versus 492.5 ± 64.0 mg/cm3; p = 0.006) and attenuation (0.44 ± 0.07 versus 0.47 ± 0.04 1/cm; p = 0.004) were significantly lower in RA. Both lumbar and femoral neck BMD, as well as T-scores, were significantly lower in RA versus controls (p < 0.001 in all cases). In RA, total and cortical QCT attenuation and density were associated with age, the presence of RA, and their combination. In contrast, trabecular density and attenuation were only affected by the presence of the disease but not by age. Also in RA, total trabecular and cortical density as determined by QCT significantly correlated with lumbar and/or femoral neck BMD as measured by DXA. Finally, anti-CCP seropositivity was associated with lower trabecular density and attenuation.

Conclusions

Both DXA and QCT may be suitable to study bone metabolism in RA. Areal BMD determined by DXA may correlate with volumetric bone density measured by QCT. Moreover, trabecular osteoporosis may be associated by the underlying autoimmune-inflammatory disease, while cortical osteoporosis may rather be age-related.

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Acknowledgments

This work is supported by the OTKA 105073 research grant by the Hungarian Scientific Research Fund (H.P.B.), by the TÁMOP 4.2.4.A/2-11-1-2012-0001 National Excellence Program cofinanced by the European Union and Hungary (Z.S.), by research grant TÁMOP-4.2.2.A-11/1/KONV-2012-0031 financed by the European Union (Z.S.), and by a Bridging Fund from the University of Debrecen Faculty of Medicine (Z.S.).

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Authors and Affiliations

  1. Department of Oncology, University of Debrecen Faculty of Medicine, Debrecen, Hungary

    B. Juhász, É. Szekanecz, J. Kocsis & Z. Horváth

  2. Department of Rheumatology, University of Debrecen Faculty of Medicine, Debrecen, Hungary

    K. Gulyás, Á. Horváth, Z. Pethő, A. Váncsa, K. Hodosi, S. Szántó, G. Szűcs & Z. Szekanecz

  3. Department of Laboratory Medicine, University of Debrecen Faculty of Medicine, Debrecen, Hungary

    H. P. Bhattoa

  4. First Department of Medicine, Semmelweis University, Budapest, Hungary

    C. Horváth

Authors
  1. B. Juhász
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  2. K. Gulyás
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  3. Á. Horváth
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  4. Z. Pethő
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  5. H. P. Bhattoa
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  6. A. Váncsa
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  7. É. Szekanecz
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  8. C. Horváth
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  9. J. Kocsis
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  10. Z. Horváth
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  11. K. Hodosi
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  12. S. Szántó
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  13. G. Szűcs
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  14. Z. Szekanecz
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Corresponding author

Correspondence to Z. Szekanecz.

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Ethics statement

The study received an Institutional Review Board approval and assessments were carried out according to the Declaration of Helsinki. An informed consent was obtained from each patient.

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Juhász, B., Gulyás, K., Horváth, Á. et al. Comparison of peripheral quantitative computed tomography forearm bone density versus DXA in rheumatoid arthritis patients and controls. Osteoporos Int 28, 1271–1277 (2017). https://doi.org/10.1007/s00198-016-3850-x

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  • DOI: https://doi.org/10.1007/s00198-016-3850-x

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