Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, Gyeonggi-do, 471-701, South Korea.
Department of Neurosurgery, Hanyang University Medical Center, 222-1, Wangsimni-ro, Seongdong-gu, Seoul, 133-792, South Korea.
Osteoporos Int. 2017 Jun;28(6):1931-1938. doi: 10.1007/s00198-017-3972-9. Epub 2017 Mar 2.
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.
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.
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.
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.
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.
对于 BMI 较低的患者，骨量减少和骨质疏松症是发生寰枢关节半脱位的独立预测因素。我们的研究结果表明，患有骨质疏松症或骨质疏松症的类风湿关节炎患者，特别是 BMI 较低的患者，应定期进行筛查，以确定其颈椎状况。
类风湿关节炎（RA）患者的颈椎受累可能会对生活质量和整体健康产生严重影响。本研究旨在评估在已确诊的 RA 患者中，根据 BMI 变化，探讨寰齿间距（ADI）、寰枢关节半脱位（AAS）与全身骨密度（BMD）之间的关系。
将 ADI 转换为自然对数标度，以使所有分析的分布正态化。使用多变量线性回归分析，根据每个 BMD 分类，确定 ADI 的独立预测因素。还进行了多变量 Cox 回归分析，以确定 AAS 的独立预测因素，AAS 按照 BMI 三分位组进行分类。
共确定并纳入了 1220 名至少接受过一次或多次颈椎放射摄影和 BMD 评估的 RA 患者。我们发现，BMD 与 ADI 之间的关联（β，-0.029；95%CI，-0.059 至 0.002；p=0.070）未达到统计学意义。然而，在骨质疏松组中，ADI 随 BMI 每增加 1 而降低 3.6%（β，-0.036；95%CI，-0.061 至 -0.011；p=0.004）。在 BMI 组的第一三分位中，骨质疏松症和骨量减少组发生 AAS 的风险分别增加了约 1.5 倍和 1.8 倍。
本研究显示，BMI 较低的 RA 患者中，较低的 BMD 与 AAS 发生之间可能存在关联。需要进一步的研究来证实我们的发现。
