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Influence of systemic bone mineral density on atlantoaxial subluxation in patients with rheumatoid arthritis

Osteoporosis International volume 28, pages 1931–1938 (2017)Cite this article

Abstract

Summary

Osteopenia and osteoporosis were independent predictive factors for higher atlantoaxial subluxation occurrence in patients with lower body mass index. Our findings suggest that patients with rheumatoid arthritis with osteopenia or osteoporosis, particularly those with lower body mass index (BMI), should be screened regularly to determine the status of their cervical spines.

Introduction

Cervical spine involvement in rheumatoid arthritis (RA) patients may cause serious adverse effects on quality of life and overall health. This study aimed to evaluate the association between atlantodental interval (ADI), atlantoaxial subluxation (AAS), and systemic bone mineral density (BMD) based on BMI variations among established patients with RA.

Methods

The ADI was transformed to the natural log scale to normalize distributions for all analyses. Multivariable linear regression analyses were used to identify independent predictive factors for ADI based on each BMD classification. Multivariate Cox regression analyses were also performed to identify independent predictive factors for the risk of AAS, which were classified by tertile groups of BMI.

Results

A total of 1220 patients with RA who had undergone at least one or more cervical radiography and BMD assessments were identified and enrolled. We found that the association between BMD and ADI (β, −0.029; 95% CI, −0.059 to 0.002; p = 0.070) fell short of achieving statistical significance. However, the ADI showed a 3.6% decrease per 1 BMI increase in the osteoporosis group (β, −0.036; 95% CI, −0.061 to −0.011; p = 0.004). The osteopenia and osteoporosis groups showed about a 1.5-fold and a 1.8-fold increased risk of AAS occurrence among the first tertile of the BMI group.

Conclusions

Our study showed a possible association between lower BMD and AAS occurrence in patients with RA with lower BMI. Further studies are needed to confirm our findings.

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Acknowledgements

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Author information

Affiliations

  1. Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, Gyeonggi-do, 471-701, South Korea

    M. H. Han, J. I. Ryu, C. H. Kim, J. M. Kim & J. H. Cheong

  2. Department of Neurosurgery, Hanyang University Medical Center, 222-1, Wangsimni-ro, Seongdong-gu, Seoul, 133-792, South Korea

    K. H. Bak & H. J. Chun

Authors
  1. M. H. Han
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  2. J. I. Ryu
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  3. C. H. Kim
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  4. J. M. Kim
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  6. K. H. Bak
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  7. H. J. Chun
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Corresponding author

Correspondence to J. I. Ryu.

Ethics declarations

The study was approved by the Institutional Review Board of Hanyang University Medical Center. The retrospective nature of the study meant that the need for informed consent was waived. All patient records were de-identified and anonymized prior to analysis.

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Electronic supplementary material

Supplemental Fig. 1

Interaction plot between BMI and BMD. BMD, bone mineral density; BMI, body mass index (DOCX 1001 kb)

Supplemental Fig. 2

Interaction plots between BMI and BMD classified by BMD categories. BMD, bone mineral density; BMI, body mass index (DOCX 227 kb)

Supplemental Table 1

Univariable linear regression of the atlantodental interval classified by BMD categories according to patient characteristics. (DOCX 15 kb)

Supplemental Table 2

Univariate cox regression analysis of the development of atlantoaxial subluxation classified by tertile of BMI groups based on patient factors. (DOCX 16 kb)

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Han, M.H., Ryu, J.I., Kim, C.H. et al. Influence of systemic bone mineral density on atlantoaxial subluxation in patients with rheumatoid arthritis. Osteoporos Int 28, 1931–1938 (2017). https://doi.org/10.1007/s00198-017-3972-9

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  • DOI: https://doi.org/10.1007/s00198-017-3972-9

Keywords

  • Atlantoaxial subluxation
  • Atlantodental interval
  • Cervical spine instability
  • Rheumatoid arthritis