Rheumatoid Arthritis

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The relationship between focal erosions and generalized osteoporosis in postmenopausal women with rheumatoid arthritis

  1. Daniel H. Solomon1,†,*,
  2. Joel S. Finkelstein2,
  3. Nancy Shadick1,‡,
  4. Meryl S. LeBoff1,§,
  5. Carl S. Winalski3,¶,
  6. Margaret Stedman1,
  7. Roberta Glass1,
  8. M. Alan Brookhart1,
  9. Michael E. Weinblatt1,‖,
  10. Ellen M. Gravallese4,††

Article first published online: 28 MAY 2009

DOI: 10.1002/art.24551

Issue

Arthritis & Rheumatism

Arthritis & Rheumatism

Volume 60, Issue 6, pages 1624–1631, June 2009

Additional Information

How to Cite

Solomon, D. H., Finkelstein, J. S., Shadick, N., LeBoff, M. S., Winalski, C. S., Stedman, M., Glass, R., Brookhart, M. A., Weinblatt, M. E. and Gravallese, E. M. (2009), The relationship between focal erosions and generalized osteoporosis in postmenopausal women with rheumatoid arthritis. Arthritis & Rheumatism, 60: 1624–1631. doi: 10.1002/art.24551

Author Information

  1. 1

    Brigham and Women's Hospital, Boston, Massachusetts

  2. 2

    Massachusetts General Hospital, Boston

  3. 3

    Cleveland Clinic Foundation, Cleveland, Ohio

  4. 4

    University of Massachusetts Medical Center, Worcester

  1. †

    Dr. Solomon has received research grants from Abbott and Amgen, and has served as an unpaid member of the Data Safety and Monitoring Board and the Trial Executive Committee for Pfizer.

  2. ‡

    Dr. Shadick has received research grants from the Amgen Foundation, the Bristol-Myers Squibb Foundation, Millennium Pharmaceuticals, Biogen Idec, and Crescendo Therapeutics.

  3. §

    Dr. LeBoff owns stock or stock options in GE and Amgen.

  4. Dr. Winalski owns stock or stock options in Pfizer, has received research support from Abbott, and has served as an investigator for research at the Cleveland Clinic funded through a contract with Abbott.

  5. ‖

    Dr. Weinblatt has received consulting fees and/or research funding from Abbott, Amgen, Biogen Idec, Bristol-Myers Squibb, Genentech, Millennium Pharmaceuticals, and Riley Genomics (less than $10,000 each). He has received consulting fees from Crescendo Therapeutics (less than $10,000), and from other companies that are unrelated to this study. This information is on file at the journal.

  6. ††

    Dr. Gravallese has received consulting fees from Abbott (less than $10,000). The BRASS registry was supported by Millennium Pharmaceuticals, Riley Genomics, and Biogen Idec.

*Division of Rheumatology, Brigham and Women's Hospital, 75 Francis Street, PBB-B3, Boston, MA 02115

Publication History

  1. Issue published online: 28 MAY 2009
  2. Article first published online: 28 MAY 2009
  3. Manuscript Accepted: 25 FEB 2009
  4. Manuscript Received: 9 JUN 2008

Funded by

  • NIH. Grant Numbers: AG-027066, AR-047782, AR-055989, K24-DK-02759, AR-047665
  • CDC
  • Worcester Foundation

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Abstract

Objective

Among rheumatoid arthritis (RA) patients who have had the disease for 10 years, more than half have focal erosions, and the risk of fracture is doubled. However, there is little information about the potential relationship between focal erosions and bone mineral density (BMD). The aim of this study was to determine whether lower BMD is associated with higher erosion scores among patients with RA.

Methods

We enrolled 163 postmenopausal women with RA, none of whom were taking osteoporosis medications. Patients underwent dual x-ray absorptiometry at the hip and spine and hand radiography, and completed a questionnaire. The hand radiographs were scored using the Sharp method, and the relationship between BMD and erosions was measured using Spearman's correlation coefficients and adjusted linear regression models.

Results

Patients had an average disease duration of 13.7 years, and almost all were taking a disease-modifying antirheumatic drug. Sixty-three percent were rheumatoid factor (RF) positive. The median modified Health Assessment Questionnaire score was 0.7, and the average Disease Activity Score in 28 joints was 3.8. The erosion score was significantly correlated with total hip BMD (r = −0.33, P < 0.0001), but not with lumbar spine BMD (r = −0.09, P = 0.27). Hip BMD was significantly lower in RF-positive patients versus RF-negative patients (P = 0.02). In multivariable models that included age, body mass index, and cumulative oral glucocorticoid dose, neither total hip BMD nor lumbar spine BMD was significantly associated with focal erosions.

Conclusion

Our results suggest that hip BMD is associated with focal erosions among postmenopausal women with RA, but that this association disappears after multivariable adjustment. While BMD and erosions may be correlated with bone manifestations of RA, their relationship is complex and influenced by other disease-related factors.

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