Skip to main content

Advertisement

SpringerLink
Log in

Comparison of ultrasound and X-ray absorptiometry bone measurements in a case control study of female rheumatoid arthritis patients and randomly selected subjects in the population

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract.

To compare quantitative ultrasound (QUS) and dual-energy X-ray absorptiometry (DXA) bone measurements in female rheumatoid arthritis (RA) patients and controls were randomly selected from the population; secondly, to examine disease and demographic factors associated with these bone measurements. In a total of 115 RA patients (mean age 63.0 years) and 115 age- and gender-matched controls demographic and clinical variables were collected and heel QUS parameters [speed of sound (SOS), broadband ultrasound attenuation (BUA) and stiffness index (SI)] as well as DXA bone mineral density (BMD) at spine and hip were measured. The differences in QUS and DXA measurements between RA patients and controls were tested both on a group and on an individual level. Univariate and multivariate statistical tests were applied to explore for associations to the bone measurements. In the RA patients mean disease duration was 16.6 years, erythrocyte sedimentation rate 23.6 mm/h, M-HAQ 1.68, 28-swollen joint count 7.7, 18-deformed joint count 4.5, 50.0% were rheumatoid factor (RF) positive and 44.2% were current users of prednisolone. All bone measurements were reduced in RA patients compared with controls (SOS 1.9%, BUA 9.4%, SI 19.5%, femoral neck BMD 7.4%, total hip BMD 7.5%, spine L2–L4 BMD −3.0%). Only at spine was the BMD reduction not statistically significant (P=0.21). In the subgroup of never users of prednisolone SOS was decreased by 1.4%, BUA by 3.7%, SI by 11.0, femoral neck BMD by 2.7%, and total hip BMD by 0.6%, whereas for spine L2–L4 BMD was increased by 4.3% and only for SOS and SI was the decrease statistically significant. The QUS discriminated better than DXA between patients and controls on a group level, but this difference in favor of QUS disappeared on an individual level when the measurement errors were taken into account. Age, BMI, RF and deformed joint count, but not corticosteroids, were independently associated with at least one of the QUS and one of the DXA measures; however, the association between disease-related variables was stronger with the QUS bone measures than with the DXA bone measures. The results for the quantitative QUS bone measures seem to mainly reflect bone mass. Disease-related variables in multivariate analysis remained independently associated with all QUS measures even when adjusting for DXA bone measures. Further studies are needed to examine if QUS may reflect other aspects than bone mass and be a potential better predictor for fracture risk in RA and corticosteroid-induced osteoporosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.
Fig. 2.

Similar content being viewed by others

References

  1. Consensus Development Conference: diagnosis, prophylaxis, and treatment of osteoporosis (1993) Am J Med 94:646–650

  2. Cummings SR, Black DM, Nevitt MC, Browner W, Cauley J, Ensrud K et al. (1993) Bone density at various sites for prediction of hip fractures. The Study of Osteoporotic Fractures Research Group. Lancet 341:72–75

    Google Scholar 

  3. Legrand E, Chappard D, Pascaretti C, Duquenne M, Krebs S, Rohmer V et al. (2000) Trabecular bone microarchitecture, bone mineral density, and vertebral fractures in male osteoporosis. J Bone Miner Res 15:13–19

    Google Scholar 

  4. Haugeberg G, Uhlig T, Falch JA, Halse JI, Kvien TK (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

    Google Scholar 

  5. Haugeberg G, Uhlig T, Falch JA, Halse JI, Kvien TK (2000) Reduced bone mineral density in male rheumatoid arthritis patients: frequencies and associations with demographic and disease variables in ninety-four patients in the Oslo County Rheumatoid Arthritis Register. Arthritis Rheum 43:2776–2784

    Google Scholar 

  6. Spector TD, Hall GM, McCloskey EV, Kanis JA (1993) Risk of vertebral fracture in women with rheumatoid arthritis. Br Med J 306:558

    Google Scholar 

  7. Peel NF, Moore DJ, Barrington NA, Bax DE, Eastell R (1995) Risk of vertebral fracture and relationship to bone mineral density in steroid treated rheumatoid arthritis. Ann Rheum Dis 54:801–806

    Google Scholar 

  8. Hooyman JR, Melton LJ, Nelson AM, O'Fallon WM, Riggs BL (1984) Fractures after rheumatoid arthritis. A population-based study. Arthritis Rheum 27:1353–1361

    Google Scholar 

  9. Huusko TM, Korpela M, Karppi P, Avikainen V, Kautiainen H, Sulkava R (2001) Threefold increased risk of hip fractures with rheumatoid arthritis in Central Finland. Ann Rheum Dis 60:521–522

    Google Scholar 

  10. Luengo M, Picado C, Del Rio L, Guanabens N, Montserrat JM, Setoain J (1991) Vertebral fractures in steroid dependent asthma and involutional osteoporosis: a comparative study. Thorax 46:803–806

    Google Scholar 

  11. Naganathan V, Jones G, Nash P, Nicholson G, Eisman J, Sambrook PN (2000)Vertebral fracture risk with long-term corticosteroid therapy: prevalence and relation to age, bone density, and corticosteroid use. Arch Intern Med 160:2917–2922

    Google Scholar 

  12. Selby PL, Halsey JP, Adams KR, Klimiuk P, Knight SM, Pal B et al. (2000) Corticosteroids do not alter the threshold for vertebral fracture. J Bone Miner Res 15:952–956

    Google Scholar 

  13. Gluer CC, Wu CY, Genant HK (1993) Broadband ultrasound attenuation signals depend on trabecular orientation: an in vitro study. Osteoporos Int 3:185–191

    Google Scholar 

  14. Gluer CC, Wu CY, Jergas M, Goldstein SA, Genant HK (1994) Three quantitative ultrasound parameters reflect bone structure. Calcif Tissue Int 55:46–52

    Google Scholar 

  15. Daens S, Peretz A, de M, V, Moris M, Bergmann P (1999) Efficiency of quantitative ultrasound measurements as compared with dual-energy X-ray absorptiometry in the assessment of corticosteroid-induced bone impairment. Osteoporos Int 10:278–283

  16. Rehman Q, Lang T, Modin G, Lane NE (2002) Quantitative computed tomography of the lumbar spine, not dual X-ray absorptiometry, is an independent predictor of prevalent vertebral fractures in postmenopausal women with osteopenia receiving long-term glucocorticoid and hormone-replacement therapy. Arthritis Rheum 46:1292–1297

    Google Scholar 

  17. Cheng S, Fan B, Wang L, Fuerst T, Fye K, Harris S et al. (1998) Ultrasound and bone mineral density assessments of the calcaneus in people with various musculoskeletal conditions. Bone 23 (Suppl):S458

  18. Blanckaert F, Cortet B, Coquerelle P, Flipo RM, Duquesnoy B, Marchandise X et al. (1997) Contribution of calcaneal ultrasonic assessment to the evaluation of postmenopausal and glucocorticoid-induced osteoporosis. Rev Rhum Engl Ed 64:305–313

    Google Scholar 

  19. Martin JC, Munro R, Campbell MK, Reid DM (1997) Effects of disease and corticosteroids on appendicular bone mass in postmenopausal women with rheumatoid arthritis: comparison with axial measurements. Br J Rheumatol 36:43–49

    Google Scholar 

  20. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS et al. (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324

    Google Scholar 

  21. Kvien TK, Glennås A, Knudsrød OG, Smedstad LM, Mowinckel P, Førre Ø (1997) The prevalence and severity of rheumatoid arthritis in Oslo: results from a county register and a population survey. Scand J Rheumatol 26:412–418

    Google Scholar 

  22. Uhlig T, Kvien TK, Glennås A, Smedstad LM, Førre Ø (1998) The incidence and severity of rheumatoid arthritis: results from a county register in Oslo, Norway. J Rheumatol 25:1078–1084

    Google Scholar 

  23. Pincus T, Summey JA, Soraci SA Jr, Wallston KA, Hummon NP (1983) Assessment of patient satisfaction in activities of daily living using a modified Stanford health assessment questionnaire. Arthritis Rheum 26:1346–1353

    Google Scholar 

  24. Orces CH, Del RI, Abel MP, Escalante A (2002) The number of deformed joints as a surrogate measure of damage in rheumatoid arthritis. Arthritis Rheum 47:67–72

    Google Scholar 

  25. Rosen C, McClung M, Ettinger M, Gallagher C, Baldwin D, Faulkner KG (1998) Heel ultrasound reference data for Caucasian women in the USA. J Clin Densitom 1:107

    Google Scholar 

  26. Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310

    Google Scholar 

  27. Madsen OR, Egsmose C, Hansen B, Sorensen OH (1998) Soft tissue composition, quadriceps strength, bone quality and bone mass in rheumatoid arthritis. Clin Exp Rheumatol 16:27–32

    Google Scholar 

  28. Hans D, Arlot ME, Schott AM, Roux JP, Kotzki PO, Meunier PJ (1995) Do ultrasound measurements on the os calcis reflect more the bone microarchitecture than the bone mass?: a two-dimensional histomorphometric study. Bone 16:295–300

    Google Scholar 

  29. Orwoll ES, Oviatt SK, Mann T (1990) The impact of osteophytic and vascular calcifications on vertebral mineral density measurements in men. J Clin Endocrinol Metab 70:1202–1207

    Google Scholar 

  30. Masud T, Langley S, Wiltshire P, Doyle DV, Spector TD (1993) Effect of spinal osteophytosis on bone mineral density measurements in vertebral osteoporosis. Br Med J 307:172–173

    Google Scholar 

  31. Wolfe F, Hawley DJ, Cathey MA (1991) Clinical and health status measures over time: prognosis and outcome assessment in rheumatoid arthritis. J Rheumatol 18:1290–1297

    Google Scholar 

  32. Sambrook P, Raj A, Hunter D, Naganathan V, Mason R, Robinson B (2001) Osteoporosis with low dose corticosteroids: contribution of underlying disease effects and discriminatory ability of ultrasound versus bone densitometry. J Rheumatol 28:1063–1067

    Google Scholar 

  33. Iki M, Kajita E, Mitamura S, Nishino H, Yamagami T, Nagahama N (1999) Precision of quantitative ultrasound measurement of the heel bone and effects of ambient temperature on the parameters. Osteoporos Int 10:462–467

    Google Scholar 

  34. Gough AK, Lilley J, Eyre S, Holder RL, Emery P (1994) Generalised bone loss in patients with early rheumatoid arthritis. Lancet 344:23–27

    Google Scholar 

  35. Sambrook PN, Cohen ML, Eisman JA, Pocock NA, Champion GD, Yeates MG (1989) Effects of low dose corticosteroids on bone mass in rheumatoid arthritis: a longitudinal study. Ann Rheum Dis 48:535–538

    Google Scholar 

  36. Buckley LM, Leib ES, Cartularo KS, Vacek PM, Cooper SM (1995) Effects of low dose corticosteroids on the bone mineral density of patients with rheumatoid arthritis. J Rheumatol 22:1055–1059

    Google Scholar 

  37. Laan RF, van Riel PL, van Erning LJ, Lemmens JA, Ruijs SH, van de Putte LB (1992) Vertebral osteoporosis in rheumatoid arthritis patients: effect of low dose prednisone therapy. Br J Rheumatol 31:91–96

    Google Scholar 

  38. Leboff MS, Wade JP, Mackowiak S, el-Hajj F, Zangari M, Liang MH (1991) Low dose prednisone does not affect calcium homeostasis or bone density in postmenopausal women with rheumatoid arthritis. J Rheumatol 18:339–344

    Google Scholar 

  39. Verhoeven AC, Boers M (1997) Limited bone loss due to corticosteroids; a systematic review of prospective studies in rheumatoid arthritis and other diseases. J Rheumatol 24:1495–1503

    Google Scholar 

  40. Haugeberg G, Lodder MC, Lems WF, Uhlig T, Dijkmans BA, Kvien TK et al. (2001) Associates with and extent of reduced bone mineral density (BMD) in female rheumatoid arthritis patients: the Oslo, Truro, and Amsterdam (OSTRA) collaborative study. Ann Rheum Dis 60:S254

    Google Scholar 

  41. Lodder MC, Haugeberg G, Lems WF, Orstavik RE, Dijkmans BA, Kvien TK et al. (2001) Vertebral deformities in rheumatoid arthritis: the Oslo, Truro, and Amsterdam collaborative study. Ann Rheum Dis 60:S253

    Google Scholar 

Download references

Acknowledgements. We thank P. Mowinckel for statistical advice. We gratefully appreciate our technicians E. Haavardsholm, I. Müller, S. Arnkvaern, M. Sveinsson, A.K. Kongtorp, P. Bøyesen, S. Schøyen Seterelv, S. Eghtedari, and Å. Ask Hyldmo for expert technical assistance. This work was supported in part by grants from The Research Council of Norway, Lions Clubs International MD 104 Norway, The Norwegian Rheumatism Association, The Norwegian Women's Public Health Association, Trygve Gythfeldt and wife's legacy, Grethe Harbitz's legacy, and Marie and Else Mustad's legacy, The Norwegian Osteoporosis Foundation.

Author information

Authors and Affiliations

  1. Oslo City Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway

    G. Haugeberg, R. E. Ørstavik, T. Uhlig & T. K. Kvien

  2. Department of Internal Medicine, Aker Hospital, Oslo, Norway

    J. A. Falch

  3. Osteoporosis Clinic, Oslo, Norway

    J. I. Halse

  4. Department of Rheumatology, Sørlandet Hospital, Servicebox 416, 4604, Kristiansand, Norway

    G. Haugeberg

Authors
  1. G. Haugeberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. E. Ørstavik
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T. Uhlig
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. A. Falch
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. I. Halse
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. T. K. Kvien
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. Haugeberg.

Appendix

Appendix

The equation for short-term in vivo precision based on duplicate BMD measurements is CV%={ (∑D2/2N)√/mean}×100, where N is number of paired observations, D is the difference between the two measurements for each subject, and mean of all BMD measurements.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Haugeberg, G., Ørstavik, R.E., Uhlig, T. et al. Comparison of ultrasound and X-ray absorptiometry bone measurements in a case control study of female rheumatoid arthritis patients and randomly selected subjects in the population. Osteoporos Int 14, 312–319 (2003). https://doi.org/10.1007/s00198-002-1365-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-002-1365-0

Keywords

Search

Navigation