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Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 1995 Oct;54(10):801–806. doi: 10.1136/ard.54.10.801

Risk of vertebral fracture and relationship to bone mineral density in steroid treated rheumatoid arthritis.

N F Peel 1, D J Moore 1, N A Barrington 1, D E Bax 1, R Eastell 1
PMCID: PMC1010013  PMID: 7492217

Abstract

OBJECTIVES--To determine the prevalence of vertebral fracture in postmenopausal women with steroid treated rheumatoid arthritis (RA), and whether the risk of vertebral fracture could be predicted from measurements of bone mineral density (BMD). METHODS--Vertebral deformities were defined from spine radiographs in 76 postmenopausal women with steroid treated RA (aged 50-79 years) and 347 age matched women from a population based group, using a morphometric technique. Lumbar spine (LS) BMD was measured by dual energy x ray absorptiometry. RESULTS--The odds ratio for vertebral fracture in the women with RA was 6.2 (95% confidence interval 3.2 to 12.3). The decrease in LS-BMD was less than expected for the observed prevalence of vertebral fracture and, among the women with RA, LS-BMD was not lower in those with vertebral fractures. CONCLUSIONS--We conclude that patients with steroid treated RA may have abnormal bone quality, and that LS-BMD cannot be used to predict the risk of vertebral fracture in these patients.

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Selected References

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  1. Als O. S., Gotfredsen A., Christiansen C. The effect of glucocorticoids on bone mass in rheumatoid arthritis patients. Influence of menopausal state. Arthritis Rheum. 1985 Apr;28(4):369–375. doi: 10.1002/art.1780280403. [DOI] [PubMed] [Google Scholar]
  2. Als O. S., Gotfredsen A., Riis B. J., Christiansen C. Are disease duration and degree of functional impairment determinants of bone loss in rheumatoid arthritis? Ann Rheum Dis. 1985 Jun;44(6):406–411. doi: 10.1136/ard.44.6.406. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Arend W. P., Joslin F. G., Thompson R. C., Hannum C. H. An IL-1 inhibitor from human monocytes. Production and characterization of biologic properties. J Immunol. 1989 Sep 15;143(6):1851–1858. [PubMed] [Google Scholar]
  4. Arnett F. C., Edworthy S. M., Bloch D. A., McShane D. J., Fries J. F., Cooper N. S., Healey L. A., Kaplan S. R., Liang M. H., Luthra H. S. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988 Mar;31(3):315–324. doi: 10.1002/art.1780310302. [DOI] [PubMed] [Google Scholar]
  5. Compston J. E., Crawley E. O., Evans C., O'Sullivan M. M. Spinal trabecular bone mineral content in patients with non-steroid treated rheumatoid arthritis. Ann Rheum Dis. 1988 Aug;47(8):660–664. doi: 10.1136/ard.47.8.660. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Cooper C., Poll V., McLaren M., Daunt S. O., Cawley M. I. Alterations in appendicular skeletal mass in patients with rheumatoid, psoriatic, and osteoarthropathy. Ann Rheum Dis. 1988 Jun;47(6):481–484. doi: 10.1136/ard.47.6.481. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Cummings S. R., Black D. M., Nevitt M. C., Browner W., Cauley J., Ensrud K., Genant H. K., Palermo L., Scott J., Vogt T. M. Bone density at various sites for prediction of hip fractures. The Study of Osteoporotic Fractures Research Group. Lancet. 1993 Jan 9;341(8837):72–75. doi: 10.1016/0140-6736(93)92555-8. [DOI] [PubMed] [Google Scholar]
  8. Eastell R., Cedel S. L., Wahner H. W., Riggs B. L., Melton L. J., 3rd Classification of vertebral fractures. J Bone Miner Res. 1991 Mar;6(3):207–215. doi: 10.1002/jbmr.5650060302. [DOI] [PubMed] [Google Scholar]
  9. Eastell R., Wahner H. W., O'Fallon W. M., Amadio P. C., Melton L. J., 3rd, Riggs B. L. Unequal decrease in bone density of lumbar spine and ultradistal radius in Colles' and vertebral fracture syndromes. J Clin Invest. 1989 Jan;83(1):168–174. doi: 10.1172/JCI113854. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Eastgate J. A., Symons J. A., Wood N. C., Grinlinton F. M., di Giovine F. S., Duff G. W. Correlation of plasma interleukin 1 levels with disease activity in rheumatoid arthritis. Lancet. 1988 Sep 24;2(8613):706–709. doi: 10.1016/s0140-6736(88)90185-7. [DOI] [PubMed] [Google Scholar]
  11. Garton M. J., Reid D. M. Bone mineral density of the hip and of the anteroposterior and lateral dimensions of the spine in men with rheumatoid arthritis. Effects of low-dose corticosteroids. Arthritis Rheum. 1993 Feb;36(2):222–228. doi: 10.1002/art.1780360213. [DOI] [PubMed] [Google Scholar]
  12. Hochberg M. C., Chang R. W., Dwosh I., Lindsey S., Pincus T., Wolfe F. The American College of Rheumatology 1991 revised criteria for the classification of global functional status in rheumatoid arthritis. Arthritis Rheum. 1992 May;35(5):498–502. doi: 10.1002/art.1780350502. [DOI] [PubMed] [Google Scholar]
  13. Laan R. F., van Riel P. L., van Erning L. J., Lemmens J. A., Ruijs S. H., van de Putte L. B. Vertebral osteoporosis in rheumatoid arthritis patients: effect of low dose prednisone therapy. Br J Rheumatol. 1992 Feb;31(2):91–96. doi: 10.1093/rheumatology/31.2.91. [DOI] [PubMed] [Google Scholar]
  14. Laan R. F., van Riel P. L., van de Putte L. B. Bone mass in patients with rheumatoid arthritis. Ann Rheum Dis. 1992 Jun;51(6):826–832. doi: 10.1136/ard.51.6.826. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Leboff M. S., Wade J. P., Mackowiak S., el-Hajj Fuleihan G., Zangari M., Liang M. H. Low dose prednisone does not affect calcium homeostasis or bone density in postmenopausal women with rheumatoid arthritis. J Rheumatol. 1991 Mar;18(3):339–344. [PubMed] [Google Scholar]
  16. Peel N. F., Johnson A., Barrington N. A., Smith T. W., Eastell R. Impact of anomalous vertebral segmentation on measurements of bone mineral density. J Bone Miner Res. 1993 Jun;8(6):719–723. doi: 10.1002/jbmr.5650080610. [DOI] [PubMed] [Google Scholar]
  17. Reid D. M., Kennedy N. S., Smith M. A., Nicoll J., Brown N., Tothill P., Nuki G. Bone loss in rheumatoid arthritis and primary generalized osteoarthrosis: effects of corticosteroids, suppressive antirheumatic drugs and calcium supplements. Br J Rheumatol. 1986 Aug;25(3):253–259. doi: 10.1093/rheumatology/25.3.253. [DOI] [PubMed] [Google Scholar]
  18. Reid I. R., Evans M. C., Stapleton J. Lateral spine densitometry is a more sensitive indicator of glucocorticoid-induced bone loss. J Bone Miner Res. 1992 Oct;7(10):1221–1225. doi: 10.1002/jbmr.5650071014. [DOI] [PubMed] [Google Scholar]
  19. Ross P. D., Davis J. W., Epstein R. S., Wasnich R. D. Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med. 1991 Jun 1;114(11):919–923. doi: 10.7326/0003-4819-114-11-919. [DOI] [PubMed] [Google Scholar]
  20. Sambrook P. N., Cohen M. L., Eisman J. A., Pocock N. A., Champion G. D., Yeates M. G. Effects of low dose corticosteroids on bone mass in rheumatoid arthritis: a longitudinal study. Ann Rheum Dis. 1989 Jul;48(7):535–538. doi: 10.1136/ard.48.7.535. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Spector T. D., Hall G. M., McCloskey E. V., Kanis J. A. Risk of vertebral fracture in women with rheumatoid arthritis. BMJ. 1993 Feb 27;306(6877):558–558. doi: 10.1136/bmj.306.6877.558. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Spector T. D., McCloskey E. V., Doyle D. V., Kanis J. A. Prevalence of vertebral fracture in women and the relationship with bone density and symptoms: the Chingford Study. J Bone Miner Res. 1993 Jul;8(7):817–822. doi: 10.1002/jbmr.5650080707. [DOI] [PubMed] [Google Scholar]
  23. Tinetti M. E., Speechley M., Ginter S. F. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988 Dec 29;319(26):1701–1707. doi: 10.1056/NEJM198812293192604. [DOI] [PubMed] [Google Scholar]
  24. Verstraeten A., Dequeker J. Vertebral and peripheral bone mineral content and fracture incidence in postmenopausal patients with rheumatoid arthritis: effect of low dose corticosteroids. Ann Rheum Dis. 1986 Oct;45(10):852–857. doi: 10.1136/ard.45.10.852. [DOI] [PMC free article] [PubMed] [Google Scholar]

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