Takahashi Kengo, Setoguchi Takao, Tawaratsumida Hiroki, Arishima Yoshiya, Tominaga Hiroyuki, Ishidou Yasuhiro, Nagano Satoshi, Shigemizu Sanae, Aoki Noriko, Akimoto Masaki, Otsubo Hideo, Matsuda Takemasa, Kakoi Hironori, Izumi Toshihiko, Nakamura Shunsuke, Yokouchi Masahiro, Sunahara Nobuhiko, Komiya Setsuro
Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
Japanese Red Cross Kagoshima Hospital, Kagoshima, Japan.
BMC Musculoskelet Disord. 2015 Sep 30;16:269. doi: 10.1186/s12891-015-0732-x.
Osteoporosis is a complication of rheumatoid arthritis (RA). We identified risk factors for osteoporosis during treatment with biologics.
Femoral neck bone mineral density (BMD) was measured in 186 patients with biologics-treated RA. We compared the characteristics of those with BMD ≥70% of young adult mean (YAM) and those with BMD <70% of YAM, and undertook multivariable logistic regression analysis to identify risk factors for bone loss.
Mean age and disease duration, the proportion of females, scores in the Modified Health Assessment Questionnaire and history of vertebral fracture were significantly greater in the BMD <70% of YAM group, but body mass index (BMI) was significantly lower in the BMD <70% of YAM group. There was no significant difference between the groups in terms of other biomarkers of RA activity, the proportion treated with methylprednisolone, or the duration or choice of biologics. The proportions of patients treated with anti-osteoporosis drugs and parathyroid hormone were significantly higher in the BMD <70% of YAM group. In the multivariable analysis, advanced age, female, longer disease duration, history of past thoracic or lumbar vertebral fracture, higher Steinbrocker classification and lower BMI were significant factors for BMD <70% of YAM.
We identified risk factors for bone loss in patients with RA treated with biologics. Before suppression of disease activity by biologics, bone loss might already be advanced.
We recommend that patients with RA who possess these risk factors be considered for earlier and more intense treatment to prevent bone loss, as well as addressing RA disease progression.
骨质疏松是类风湿关节炎（RA）的一种并发症。我们确定了生物制剂治疗期间骨质疏松的风险因素。
对186例接受生物制剂治疗的RA患者测量股骨颈骨密度（BMD）。我们比较了BMD≥年轻成人均值（YAM）的70%的患者与BMD<YAM的70%的患者的特征，并进行多变量逻辑回归分析以确定骨质流失的风险因素。
BMD<YAM的70%组的平均年龄和病程、女性比例、改良健康评估问卷评分和椎体骨折病史显著更高，但BMD<YAM的70%组的体重指数（BMI）显著更低。两组在RA活动的其他生物标志物、接受甲基泼尼松龙治疗的比例、生物制剂的使用持续时间或选择方面无显著差异。BMD<YAM的70%组接受抗骨质疏松药物和甲状旁腺激素治疗的患者比例显著更高。在多变量分析中，高龄、女性、病程较长、既往胸腰椎椎体骨折病史、较高的斯坦布鲁克分类和较低的BMI是BMD<YAM的70%的显著因素。
我们确定了接受生物制剂治疗的RA患者骨质流失的风险因素。在生物制剂抑制疾病活动之前，骨质流失可能已经很严重。
我们建议，对于有这些风险因素的RA患者，应考虑更早、更强化的治疗，以预防骨质流失，并应对RA疾病进展。
