Departamento de Microbiología y Patología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, 44340 Guadalajara, JAL, Mexico.
Unidad Médica Familiar 97, Instituto Mexicano del Seguro Social (IMSS), 46470 Magdalena, JAL, Mexico.
Biomed Res Int. 2021 Aug 30;2021:5567666. doi: 10.1155/2021/5567666. eCollection 2021.
Fracture risk assessment tool (FRAX) index was developed for estimating of the 10-year risk of major or hip osteoporotic fracture. To date, there is insufficient information regarding the correlation between FRAX and serum bone turnover markers (BTMs), such as soluble ligand of receptor activator of nuclear factor-B (sRANKL), osteoprotegerin (OPG), and other molecules related with secondary osteoporosis in rheumatoid arthritis (RA). Therefore, this study is aimed at assessing the correlation between the FRAX and serum levels of sRANKL, OPG, sRANKL/OPG ratio, Dickkopf-1 (DKK-1), and sclerostin (SOST) in RA.
Cross-sectional study included 156 postmenopausal women with RA. Bone mineral density (BMD) was measured at lumbar spine (L1-L4) and total hip using dual-energy X-ray absorptiometry (DXA). RA patients were divided into (A) RA + osteoporosis and (B) RA without osteoporosis. FRAX scores were calculated including the total hip BMD. Serum sRANKL, OPG, DKK-1, and SOST levels were measured by ELISA. Pearson tests were used for assessing the correlation between serum levels of these molecules and FRAX scores in RA.
The RA + osteoporosis group had elevated sRANKL levels ( = 0.005), higher sRANKL/OPG ratio ( = 0.017), decreased DKK-1 ( = 0.028), and lower SOST levels ( < 0.001). Low total hip BMD correlated with high sRANKL ( = 0.001) and sRANKL/OPG ratio ( = 0.005). Total hip and lumbar spine BMD correlated with DKK-1 ( = 0.009 and = 0.05, respectively) and SOST levels ( < 0.001 and < 0.001, respectively). Higher sRANKL levels and sRANKL/OPG ratio correlated with estimated 10-year risk of a major osteoporotic fractures ( = 0.003 and = 0.003, respectively) and hip fracture ( = 0.002 and = 0.006, respectively). High serum SOST levels were associated with a low estimated 10-year risk of a major osteoporotic fracture ( = 0.003) and hip fracture ( = 0.009).
High sRANKL levels and sRANKL/OPG ratio can be useful to detect a subgroup of RA patients who has an increased 10-year risk of major and hip osteoporotic fractures.
骨折风险评估工具（FRAX）指数是为评估主要或髋部骨质疏松性骨折的 10 年风险而开发的。迄今为止，关于 FRAX 与血清骨转换标志物（BTMs）之间的相关性的信息还不够充分，例如核因子受体激活配体的可溶性受体（sRANKL）、骨保护素（OPG）和与类风湿关节炎（RA）继发性骨质疏松症相关的其他分子。因此，本研究旨在评估 FRAX 与 RA 患者血清 sRANKL、OPG、sRANKL/OPG 比值、Dickkopf-1（DKK-1）和硬化蛋白（SOST）水平之间的相关性。
本横断面研究纳入了 156 名绝经后 RA 患者。采用双能 X 线吸收法（DXA）测量腰椎（L1-L4）和全髋关节的骨密度（BMD）。根据是否存在骨质疏松症，将 RA 患者分为（A）RA+骨质疏松症和（B）RA 无骨质疏松症。计算 FRAX 评分，包括全髋关节 BMD。采用 ELISA 法测定血清 sRANKL、OPG、DKK-1 和 SOST 水平。采用 Pearson 检验评估这些分子的血清水平与 RA 患者 FRAX 评分之间的相关性。
RA+骨质疏松症组的 sRANKL 水平升高（ = 0.005），sRANKL/OPG 比值较高（ = 0.017），DKK-1 降低（ = 0.028），SOST 水平较低（ < 0.001）。全髋关节 BMD 与高 sRANKL（ = 0.001）和 sRANKL/OPG 比值（ = 0.005）相关。全髋关节和腰椎 BMD 与 DKK-1（ = 0.009 和 = 0.05）和 SOST 水平（ < 0.001 和 < 0.001）相关。高 sRANKL 水平和 sRANKL/OPG 比值与主要骨质疏松性骨折（ = 0.003 和 = 0.003）和髋部骨折（ = 0.002 和 = 0.006）的 10 年估计风险相关。高血清 SOST 水平与主要骨质疏松性骨折（ = 0.003）和髋部骨折（ = 0.009）的 10 年估计风险较低相关。
高 sRANKL 水平和 sRANKL/OPG 比值可用于检测 RA 患者中具有较高主要和髋部骨质疏松性骨折 10 年风险的亚组。
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