Summary
To determine whether the osteopenia of rheumatoid arthritis (RA) is due to reduction of trabecular bone mass (TBV) and/or cortical width (CW), we evaluated these parameters by bone histomorphometry; we also measured the calciotropic hormones parathormone(PTH) and calcitonin (CT), vitamin D [25(OH)D] and the biological markers of bone remodeling in a group of patients with RA. Study subjects were divided into Group C — premenopausal patients, and Group A — menopausal patients and men of the same ages. These groups were compared to two agematched control groups, B and D. In both A vs. B and C vs. D, TBV and CW were significantly lower in patients. There were no differences in PTH or CT, but 25(OH)D was significantly reduced, and BGP, OHP/Cr and AP were raised in patients. Patients also exhibited TBV loss in more than 55% and CW loss in more than 98%. These changes suggest that the decline in bone mass, mainly cortical, but also trabecular, is due to increased bone turnover and enhanced resorption and seem to reflect intrinsic alterations of RA.
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References
Baarwell, R. Disease of the Joints. London, Hardwicke, 1865.
Saville, P., Karmosh, D. Osteoporosis of rheumatoid arthritis: influence of age, sex and corticosteroid. Arthritis Rheum 1967, 10, 423–430.
Duncan, H., Frost, H.M., Villanueva, A.R., Singer, J.W. The osteoporosis of rheumatoid arthritis. Arthritis Rheum 1965, 8, 943–954.
Kennedy, A.C., Lindsay, R. Bone involvement in rheumatoid arthritis. Clin Rheum Dis 1977, 3, 403–420.
Espinoza, L.R. Rheumatoid arthritis: etiopathogenetic considerations. Clin Lab Med 1986, 6, 27–40.
Duncan, H. Osteoporosis in rheumatoid arthritis and corticosteroid-induced osteoporosis. Orthop Clin Norh Am 1972, 3, 571–583.
Rico, H., Del Rio, A., Ciguenza, G., Diaz, J., Espinos, D. Prevalencia de la osteoporosis en la artritis reumatoide y factores de influencia. Rev Esp Reumatol 1978, 5, 37–46.
Zanzi, I., Roginski, M.S., Ellis, K.J., Blau, S., Chon, S.H. Skeletal mass in rheumatoid arthritis: a comparison with forearm bone mineral content. Am J Rheumatol 1976, 126, 1305–1306.
Kennedy, A.C., Body, K., Willians, E.D. Whole body elemental composition during drug treatment of rheumatoid arthritis: a preliminary study. Ann Rheum Dis 1979, 38, 137–140.
Meunier, P.J., Coupron, P. Iliac trabecular bone volume in 236 controls. Representativeness of iliac crest. Ed: Jaworski, Z.F.G, In: Proc Firts Workshop Bone Morphometry. Ottawa, University Ottawa Press, 1973, 100–105.
Meisen, F., Mosekilde, L. The role of bone biopsy in the diagnosis of metabolic bone disease. Orthop Clin North Am 1981, 12, 571–602.
Talmage, R.V. A study of the effect of parathyroid hormone on bone remodelling and calcium homeostasis. Clin Orthop 1967, 54, 163–173.
Nordin, B.E.C. Metabolic Bone Disease. London, Churchill-Livingstone, 1973.
Hernandez, E.R., Rico, H., Diaz-Mediavilla, J., Diaz-Rubio, E., Sanz, J. Volumen trabecular oseo en una muestra de poblacion espanola. An Med Intern 1987, 4, 375–378.
Prockop, D.J., Sjoerdsma, A. Significance of hydroxyproline in man. J Clin Invest 1961, 40, 843–849.
Tausky, H.H. A microcolorimetric determination of creatinine in urine by Jaffe reaction. J Biol Chem 1954, 208, 853–856.
Haddad, J.G., Chyu, K.G. Competitive proteinbinding radio assay for 25-hydroxycholesterol. J Clin Endocrinol Metab 1971, 33, 992–995.
Byers, P., Smith, R. Trephine for full thickness iliac crest biopsy. Lancet 1967, 1, 682–683.
Villanueva, A.R. A bone stain for osteoid seams in fresh unembebbed, mineralized bone. Stain Technol 1974, 49, 1–8.
Rosenspire, K.C., Kennedy, A.C., Steinbach, J. Investigation of the metabolic activity of bone in rheumatoid arthritis. J Rheumatol 1980, 7, 469–473.
Rajapakse, C., Thompson, R., Grennan, O.M. Increased bone metabolism in the rheumatoid arthritis as measurement by the whole-body retention of 99-TCM-methylene diphosphonate. Ann Rheum Dis 1983, 42, 138–141.
Als, O.S., Gotfredsenn, A., Christiansen, C. The effect of glucocorticoids on bone mass in rheumatoid arthritis patients. Arthritis Rheum 1985, 28, 369–375.
Sambrook, P.N., Eisman, J.A., Champion, G.D., Yates, M.G., Pocock, N.A., Esbri, S. Determinants of axial bone loss in rheumatoid arthritis. Arthritis Rheum 1987, 30, 721–728.
Steen-Hansen, E., Hove, B., Andresen, J. Bone mass in patients with rheumatoid arthritis. Skeletal Radiol 1987, 16, 556–559.
Dequeker, J. Quantitative radiology: radiogrametry of cortical bone. Br J Radiol 1976, 22, 3–8.
Julkunen, H. Medical aspects in the treatment of femoral neck fracture with rheumatoid arthritis. Scand J Rheumatol 1974, 3, 13.
Stromquist, B. Hip fracture in rheumatoid arthritis. Acta Orthop Scand 1984, 55, 624–628.
Bird, H.A., Wright, V., Hennes, U., Theiss, E. Comparison of serum 1,25-dihydroxycholecalciferol concentrations in rheumatoid arthritis and osteoarthritis. Ann Rheum Dis 1982, 41, 257–258.
Sambrook, P.N., Abeyasekera, G., Ansell, B.M., Foster, S., Gumpell, J.M., Hill, P.A., Reeve, J., Stevenson, J.C. Calcium absorption in rheumatoid arthritis. Ann Rheum Dis 1985, 44, 585–588.
Als, O.S., Riis, B., Christiansen, C. Serum concentration of vitamin D metabolites in rheumatoid arthritis. Clin Rheumatol 1987, 6, 238–243.
Maddison, P.S., Bacon, P.B. Vitamin D deficiency, spontaneous fractures and osteopenia in rheumatoid arthritis. Br Med J 1974, 2, 433–435.
Kokof, F., Kuska, J., Bialas, B. Parathormone, calcitonin, 25-hydroxycalciferol and bone histology in patients with rheumatoid arthritis. Aktuel Rheumatol 1983, 8, 118–122.
Lips, P., Van Soesbergen, R., Bloot, A., Netelenbos, J.C. Bone histomorphometry in rheumatoid arthritis. Bone 1985, 6, 415.
Kennedy, A.C., Allam, B.F., Rooney, P.J. Hypercalcemia in rheumatoid arthritis: investigation of its causes and implications. Ann Rheum Dis 1979, 38, 401–412.
Crips, A.J., Helliwell, M., Grahame, R. The effect of hyperparathyroidism on the course of rheumatoid arthritis. Br J Rheumatol 1983, 22, 22–28.
Andress, D.L., Endres, D.B., Maloney, N.A., Kopp, J.B., Coburn, J.W., Sherrad, D.J. Comparison of parathyroid hormone assay with bone histomorphometry in renal osteodystrophy. J Clin Endocrinol Metab 1987, 64, 1163–1169.
Ng, K.C., Revell, P.A., Beer, M., Boucher, B.J., Cohen, R.D., Currey, H.L.F. Incidence of metabolic bone disease in rheumatoid arthritis and osteoarthritis. Ann Rheum Dis 1984, 43, 37–377.
Baker, M.R., Peacock, M., Nordin, B.E.C. The decline vitamin D status with age. Age Ageing 1980, 9, 249–252.
Haussler, M.R., Drenzer, M.K., Pikc, J.W., Chandler, J.S., Hagan, L.A. Assay of 1,25 dihydroxyvitamin D and other active metabolites in serum: applications to animals and humans. Eds: Norman, A.V. et al. In: Vitamin D, Basic Research and Its Clinical Application. Berlin, DeGruyter, 1979, 189–196.
Sambrook, P.N., Ansell, B.M., Gumpel, J.A., Hesp, R., Reeve, J., Zanelli, J.M. Bone turnover in early rheumatoid arthritis. Bone 1985, 6, 280.
Rico, H., Cabranes, J.A., Hernandez, E.R., Gomez-Castresana, F. Diferencias en la osteocalcina en pacientes con artritis reumatoide de presentacion tempranna o tardia no sometidos a tratamiento. An Med Intern 1987, 4, 113–115.
Weisman, M.H., Orth, R.W., Catherwood, B.D., Manolagas, S.C., Feftos, L.J. Measures of bone loss in rheumatoid arthritis. Arch Intern Med 1986, 146, 701–704.
Couch, M., Woods, D.A., Gallagher, J.A., Preston, C.J., Coulton, L.A., Russell, R.G.G.G., Kanis, J.A., Dickson, I.R., Poser, J.W. Considerations when measuring serum osteocalcin. Bone 1985, 6, 59.
Gevers, G., Devos, P., DeRoo, M., Dequeker, J. Increased levels of osteocalcin (Bone Gla Protein) in rheumatoid arthritis (RA). Bone 1985, 6, 482.
Shimizu, U., Shiozawa, S., Shiozawa, K. Quantitative histologic studies on the pathogenesis of periarticular osteoporosis in rheumatoid arthritis. Arthritis Rheum 1985, 28, 25–31.
Als, O.S., Gotfredsen, A., Riis, B.J., Christiansen, C. Are disease duration and degree of functional impairement determinants of bone loss in rheumatoid arthritis? Ann Rheum Dis 1985, 44, 406–411.
Lian, J.L., Gundberg, C.M. Osteocalcin. Clin Orthop 1988, 226, 267–291.
Ekestam, E.A., Ljunghall, S., Hallgren, R. Serum osteocalcin in rheumatoid arthritis and other inflammatory arthritis, relation between inflammatory activity and the effect of glucocorticoids and remission-inducing drugs. Ann Rheum Dis 1986, 45, 484–490.
Kendall, M.J., Cockel, R., Becker, J., Hawkins, C.F. Raised serum alkaline phosphatase in rheumatoid disease. Arthritis Rheum Dis 1970, 29, 537–540.
Rau, R., Kuhn, H.A. Die leber bei der progredientchronischen Polyarthritis. Schweiz Med Wochenschr 1972, 102, 635–640.
Wordworth, B.P., Vipond, S., Woods, C.G., Mowat, A.G. Metabolic bone disease among in-patients with rheumatoid arthritis. Br J Rheumatol 1984, 23, 251–257.
Pettersson, T., Wegelius, O. Biopsy diagnosis of amyloidosis in rheumatoid arthritis. Gastroenterology 1972, 62, 22–27.
Eastgate, J.A., Symons, J.A., Wood, N.C., Grinlinton, F.M., DiGiovine, F.S., Duff, G.W. Correlation of plasma interleukin 1 levels with disease activity in rheumatoid arthritis. Lancet 1988, 2, 706–709.
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Rico, H., Hernandez, E.R., Gomez-Castresana, F. et al. Osteopenia in rheumatoid arthritis: a biochemical, hormonal and histomorphometric study. Clin Rheumatol 9, 63–68 (1990). https://doi.org/10.1007/BF02030244
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DOI: https://doi.org/10.1007/BF02030244