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Bone-density testing interval and transition to osteoporosis in patients with rheumatoid arthritis

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Abstract

Summary

The study aims to evaluate the rate of transition to osteoporosis in 360 RA patients and estimate the rescreening intervals of bone mineral density (BMD) testing. Osteoporosis was newly developed in 24.8 % during mean follow-up of 7.4 years. The estimated time of a BMD testing interval was dependent on the baseline T-score in RA patients.

Introduction

Although BMD testing is routinely performed in RA patients, the interval between BMD tests has not been determined.

Methods

We retrospectively recruited 360 consecutive female patients with RA, who underwent repeated BMD testing, with a mean age of 53.7 ± 10.2 years and a mean follow-up duration of 7.4 ± 5.0 years. We stratified the study participants into five groups based on their baseline T-score range. The testing interval was defined as the estimated time for 10 % of patients in each subgroup to transition to osteoporosis. Competing-risk analyses were performed with sensitivity analysis by menopausal status and risk factors for transition to osteoporosis.

Results

At baseline, 15 % of screened patients had osteoporosis, and during follow-up, that proportion increased to 24.8 %. The estimated BMD testing interval for 10 % of patients to develop osteoporosis was 9.6 years for those with normal BMD, 7.6 years for those with mild osteopenia, 4.7 years for those with moderate osteopenia, and 2.1 years for those with severe osteopenia. No significant risk factor for transition to osteoporosis was identified in this cohort.

Conclusions

Our data indicate that osteoporosis will develop in less than 10 % of female RA patients during rescreening intervals of approximately 9 years for those with normal bone density at baseline, 7 years for those with mild osteopenia, 4 years for those with moderate osteopenia, and 2 years for those with severe osteopenia at baseline. BMD interval in RA patients could be adjusted according to their baseline BMD T-scores.

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References

  1. Scott DL, Wolfe F, Huizinga TW (2010) Rheumatoid arthritis. Lancet 376:1094–1108

    Article  PubMed  Google Scholar 

  2. Deodhar AA, Woolf AD (1996) Bone mass measurement and bone metabolism in rheumatoid arthritis: a review. Br J Rheumatol 35:309–322

    Article  CAS  PubMed  Google Scholar 

  3. Haugeberg G, Uhlig T, Falch JA et al (2000) Bone mineral density and frequency of osteoporosis in female patients with rheumatoid arthritis: results from 394 patients in the Oslo County Rheumatoid Arthritis register. Arthritis Rheum 43:522–530

    Article  CAS  PubMed  Google Scholar 

  4. Guler-Yuksel M, Bijsterbosch J, Goekoop-Ruiterman YP et al (2007) Bone mineral density in patients with recently diagnosed, active rheumatoid arthritis. Ann Rheum Dis 66:1508–1512

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. El Maghraoui A, Rezqi A, Mounach A et al (2010) Prevalence and risk factors of vertebral fractures in women with rheumatoid arthritis using vertebral fracture assessment. Rheumatology (Oxford) 49:1303–1310

    Article  Google Scholar 

  6. Ibanez M, Ortiz AM, Castrejon I et al (2010) A rational use of glucocorticoids in patients with early arthritis has a minimal impact on bone mass. Arthritis Res Ther 12:R50

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lee SG, Park YE, Park SH et al (2012) Increased frequency of osteoporosis and BMD below the expected range for age among South Korean women with rheumatoid arthritis. Int J Rheum Dis 15:289–296

    Article  PubMed  Google Scholar 

  8. U.S. Preventive Services Task Force (2011) Screening for osteoporosis: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 154:356–364

    Article  Google Scholar 

  9. Cosman F, de Beur SJ, LeBoff MS et al (2014) Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int 25:2359–2381

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Grossman JM, Gordon R, Ranganath VK et al (2010) American College of Rheumatology 2010 recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Care Res 62:1515–1526

    Article  Google Scholar 

  11. Spector TD, Hall GM, McCloskey EV et al (1993) Risk of vertebral fracture in women with rheumatoid arthritis. BMJ 306:558

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Imai K (2014) Recent methods for assessing osteoporosis and fracture risk. Recent Pat Endocr Metab Immune Drug Discov 8:48–59

    Article  CAS  PubMed  Google Scholar 

  13. Leslie WD, Majumdar SR, Lix LM et al (2014) Can change in FRAX score be used to “treat to target”? A population-based cohort study. J Bone Miner Res 29:1074–1080

    Article  PubMed  Google Scholar 

  14. Hannan MT, Felson DT, Dawson-Hughes B et al (2000) Risk factors for longitudinal bone loss in elderly men and women: the Framingham Osteoporosis Study. J Bone Miner Res 15:710–720

    Article  CAS  PubMed  Google Scholar 

  15. Melton LJ 3rd, Khosla S, Atkinson EJ et al (2000) Cross-sectional versus longitudinal evaluation of bone loss in men and women. Osteoporos Int 11:592–599

    Article  PubMed  Google Scholar 

  16. Hillier TA, Stone KL, Bauer DC et al (2007) Evaluating the value of repeat bone mineral density measurement and prediction of fractures in older women: the study of osteoporotic fractures. Arch Intern Med 167:155–160

    Article  PubMed  Google Scholar 

  17. Frost SA, Nguyen ND, Center JR et al (2009) Timing of repeat BMD measurements: development of an absolute risk-based prognostic model. J Bone Miner Res 24:1800–1807

    Article  PubMed  Google Scholar 

  18. Gourlay ML, Fine JP, Preisser JS et al (2012) Bone-density testing interval and transition to osteoporosis in older women. N Engl J Med 366:225–233

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Orimo HSY, Fukunaga M et al (1998) Diagnostic criteria of primary osteoporosis. J Bone Miner Metab 16:139–150

    Article  Google Scholar 

  20. Kanis JA, Melton LJ 3rd, Christiansen C et al (1994) The diagnosis of osteoporosis. J Bone Miner Res 9:1137–1141

    Article  CAS  PubMed  Google Scholar 

  21. World Health Organization (2007) WHO Scientific Group on the Assessment of Osteoporosis at the Primary Health Care Level. World Health Organization, Geneva

    Google Scholar 

  22. Peng L, Fine JP (2007) Nonparametric quantile inference with competing–risks data. Biometrika 94:735–744

    Article  Google Scholar 

  23. Kalbfleisch JD, Prentice RL (1980) The statistical analysis of failure time data. Wiley, New York

    Google Scholar 

  24. Kalbfleisch JD, Prentice RL (2002) The statistical analysis of failure time data, 2nd edn. Wiley Interscience, New York

    Book  Google Scholar 

  25. Marubini E, Valsecchi MG (1995) Analysing survival data from clinical trials and observational studies. Wiley, Chichester

    Google Scholar 

  26. Grossman M (1971) Parametric curve fitting. Comput J 14:169–172

    Article  Google Scholar 

  27. Fine JP, Gray RJ (1999) A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 94:496–509

    Article  Google Scholar 

  28. Clopper CJ, Pearson ES (1934) The use of confidence or fiducial limits illustrated in the case of the binomial. Biometrika 26:404–413

    Article  Google Scholar 

  29. van Staa TP, Geusens P, Bijlsma JW et al (2006) Clinical assessment of the long-term risk of fracture in patients with rheumatoid arthritis. Arthritis Rheum 54:3104–3112

    Article  PubMed  Google Scholar 

  30. Hauser B, Riches PL, Wilson JF et al (2014) Prevalence and clinical prediction of osteoporosis in a contemporary cohort of patients with rheumatoid arthritis. Rheumatology (Oxford) 53:1759–1766

    Article  Google Scholar 

  31. Dao HH, Do QT, Sakamoto J (2011) Bone mineral density and frequency of osteoporosis among Vietnamese women with early rheumatoid arthritis. Clin Rheumatol 30:1353–1361

    Article  PubMed  Google Scholar 

  32. Aizer J, Reed G, Onofrei A et al (2009) Predictors of bone density testing in patients with rheumatoid arthritis. Rheumatol Int 29:897–905

    Article  CAS  PubMed  Google Scholar 

  33. Laan RF, Buijs WC, Verbeek AL et al (1993) Bone mineral density in patients with recent onset rheumatoid arthritis: influence of disease activity and functional capacity. Ann Rheum Dis 52:21–26

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Green MJ, Deodhar AA (2001) Bone changes in early rheumatoid arthritis. Best Pract Res Clin Rheumatol 15:105–123

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We thank Rong Mao for her editorial input and Sook Young Woo for her statistical advices on this report.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, National Police Hospital, Seoul, South Korea

    J. Hwang

  2. Pharmaceutical Policy & Outcomes Research, Sungkyunkwan University School of Pharmacy, Suwon, South Korea

    E.-K. Lee

  3. Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea

    J. K. Ahn

  4. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea

    H.-S. Cha, E.-M. Koh & J. Lee

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  1. J. Hwang
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  2. E.-K. Lee
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  6. J. Lee
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Corresponding author

Correspondence to J. Lee.

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Ethical approval

All procedures performed in study were in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Ethical approval was obtained from the institutional review board of Samsung Medical Center (IRB File No. 2012-05-029). For this type of study, formal consent was not required.

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Hwang, J., Lee, EK., Ahn, J.K. et al. Bone-density testing interval and transition to osteoporosis in patients with rheumatoid arthritis. Osteoporos Int 28, 231–237 (2017). https://doi.org/10.1007/s00198-016-3703-7

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  • DOI: https://doi.org/10.1007/s00198-016-3703-7

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