Journal of Bone and Mineral Metabolism

, Volume 23, Issue 4, pp 314–317 | Cite as

Relationship between bone mineral density and urine level of NTx in rheumatoid arthritis

  • Tohgo Nonaka
  • Fumiaki Nishisaka
  • Kanji Fukuda
  • Satoshi Sohen
  • Chiaki Hamanishi


We analyzed the relationship between the level of type-I collagen N-telopeptide (NTx) in urine (U-NTx) and bone mineral density (BMD) in patients with rheumatoid arthritis (RA). The subjects were 62 female patients with RA who had experienced the menopause 5 years or more before the study commenced, and who had not been treated for osteoporosis. The mean age of the subjects was 61.6 years and the mean disease duration was 13.3 years. They were classified for global functional status (classes I to IV), and then grouped based on the presence or absence of corticosteroid administration. Bone mineral density (BMD) and U-NTx levels were measured. In the presence of corticosteroid administration (CS group; n = 40), the mean level of U-NTx/creatinine (Cr) was 88.8 nM and the percent young adult mean (%YAM) for BMD was 71.2%. In the no corticosteroid (nCS group; n = 22), the values were 72.1 nM and 78.2%, respectively. The U-NTx/Cr value and %YAM were not significantly different between the CS group and the nCS group. A negative correlation was observed between the U-NTx/Cr value and %YAM in both groups (P = 0.005 and P = 0.0265). No significant difference was observed for the U-NTx/Cr value or %YAM between the CS and nCS groups, in any class. In the CS group, a positive correlation was observed between the U-NTx/Cr value and the total dose of corticosteroid (P = 0.001), and a negative correlation was observed between the %YAM and the total dose of corticosteroid (P = 0.003). These results suggested that preventive medical treatment for osteoporosis is required for RA patients in class III, irrespective of whether they have had corticosteroid administration.

Key words

Rheumatoid arthritis Osteoporosis Corticosteroid 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Haugeberg, G, Uhlig, T, Falch, JA, Halse, JI, Kvin, TE 2000Bone mineral density and frequency of osteoporosis in female patients with rheumatoid arthritis: results from 394patients in the Oslo Country Rheumatoid Arthritis Register. Arthritis Rheum43522530Google Scholar
  2. 2.
    Ramsey-Goldman, R, Dunn, JE, Huang, CF, Dunlop, D, Rairie, JE, Fitzgerald, S 1999Frequency of fractures in women with systemic lupuserythematosus: comparison with United States population data. Arthritis Rheum42882890Google Scholar
  3. 3.
    Adachi, JD 1997Corticosteriodinduced osteoporosis. Am J Med Sci3134148Google Scholar
  4. 4.
    Dequeker, J, Maenau, K, Verwilghen, J 1995Osteoporosis in rheumatoid arthritisClin Exp Rheumatol1332126Google Scholar
  5. 5.
    American College of Rheumatology Ad Hoc Committee on Glucocorticoid-Induced Osteoporosis2001Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis: 2001 updateArthritis Rheum4414961503Google Scholar
  6. 6.
    Bikle, D 1997Biochemical markers in the assessment of bone diseaseAm J Med103427436CrossRefPubMedGoogle Scholar
  7. 7.
    Swaminathan, R 2001Biochemical markers of bone turnoverClin Chim Acta31395101CrossRefPubMedGoogle Scholar
  8. 8.
    al-Awadhi, AM, Olusi, SO, al-Zaid, N 1998Urine levels of type I collagen cross-linked N-telopeptides and deoxypyridinoline correlate with disease activity in rheumatoid arthritisClin Exp Rheumatol16569572PubMedGoogle Scholar
  9. 9.
    Arnett, FC, Edworthy, SM, Bloch, DA, McShane, DJ, Freies, JF, Cooper, NS 1988The American Rheumatism Association 1987revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum31315324Google Scholar
  10. 10.
    Steinbrocker, O, Traeger, CH, Batterman, RC 1949Therapeutic criteria in rheumatoid arthritisJAMA140659662Google Scholar
  11. 11.
    Kirwann, JR 1995The effect of glucocorticoids on joint destruction in rheumatoid arthritisN Engl J Med333142146CrossRefPubMedGoogle Scholar
  12. 12.
    Conn, DL 2001Low-dose prednisone is indicated as a standard treatment in patients with rheumatoid arthritisArthritis Rheum45462467CrossRefPubMedGoogle Scholar
  13. 13.
    van Everdingen, AA, Jacobs, JW, Siewertsz, Van, Reesema, DR, Bijlsma, JW 2002Low-dose prednisone therapy for patients with early active rheumatoid arthritis: clinical efficacy, disease-smodifying properties, and side effects. A randomized, double-blind, placebocontrolled clinical trial. Ann Intern Med136112Google Scholar
  14. 14.
    van Everdingen, AA, Siewertsz van Reesema, DR, Jacobs, JW, Bijlsma, JW 2003Low-dose glucocorticoids in early rheumatoid arthritis: discordant effects on bone mineral density and fractures?Clin Exp Rheumatol21155160PubMedGoogle Scholar
  15. 15.
    Goemaere, S, Adachi, J, Hawkins, F, Lane, N, Poubelle, P, Saag, K 1996Nonvertebral fracture and bone density in glucocorticoid-treated patientsArthritis Rheum39S8898Google Scholar
  16. 16.
    Lane, NE, Lukert, B 1998The science and therapy of glucocorticoid–induced bone lossEndocrinol Metab Clin North Am27465483CrossRefPubMedGoogle Scholar
  17. 17.
    Dequeker, J, Maenaut, K, Verwilghen, J, Westhovens, R 1995Osteoporosis in rheumatoid arthritisClin Exp Rheumatol13S2126PubMedGoogle Scholar
  18. 18.
    Sinigaglia, L, Nervetti, A, Mela, Q, Bianchi, G, Del Puente, A, Di Munno, O, Frediani, B, Cantatore, F, Pellerito, R, Bartolone, S, La Montagna, G, Adami, S 2000A multicenter cross sectional study on bone mineral density in rheumatoid arthritis. Italian study group on bone mass in rheumatoid arthritisJ Rheumatol2725822589PubMedGoogle Scholar
  19. 19.
    Jimi, E, Nakamura, I, Duong, LT, Ikebe, T, Takahashi, N, Rodan, GA, Suda, T 1999Interleukin 1 induces multinucleation and bone-resorbing activity of osteoclasts in the absence of osteoblastsstromal cells. Exp Cell Res2478493CrossRefGoogle Scholar
  20. 20.
    Kobayashi, K, Takahashi, N, Jimi, E, Udagawa, N, Takami, M, Kotake, S, Nakagawa, N, Kinosaki, M, Yamaguchi, K, Shima, N, Yasuda, H, Morinaga, T, Higashio, K, Martin, TJ, Suda, T 2000Tumor necrosis factor alpha stimulates osteoclast differentiation by a mechanism independent of the ODF/RANKLRANK interaction. J Exp Med191275286Google Scholar
  21. 21.
    Saidenbergie, KN, Bessis, N, Cohen, SM, De Vernejoul, MC, Christophe, BM 2002Osteoprotegerin and inflammationEur Cytokine Netw13144153PubMedGoogle Scholar
  22. 22.
    Eastell, R, Reid, DM, Compston, J, Cooper, C, Fogelman, I, Francis, RM, Hosking, DJ, Purdie, DW, Ralston, SH, Reeve, J, Russell, RG, Stevenson, JC, Torgerson, DJ 1998A UK Consensus Group on management of glucocorticoid-inducedosteoporosis: an update. J Intern Med244271292Google Scholar
  23. 23.
    Sohen, S, Kamiya, M, Kikuchi, H, Nonaka, T, Ueno, M, Fukuoka, H, Hamanishi, C 2001Analysis of diagnostic criteria of generalized osteoporosis in patients with rheumatoid arthritisClin Rheumatol Related Res13190195Google Scholar

Copyright information

© Springer-Verlag Tokyo 2005

Authors and Affiliations

  • Tohgo Nonaka
    • 1
  • Fumiaki Nishisaka
    • 1
  • Kanji Fukuda
    • 1
  • Satoshi Sohen
    • 2
  • Chiaki Hamanishi
    • 1
  1. 1.Department of Orthopaedic SurgeryKinki University School of MedicineOsakasayamaJapan
  2. 2.Department of Orthopaedic Surgery and Rheumatology, Nara HospitalKinki University School of MedicineNaraJapan

Personalised recommendations