Table 1.
Details of the studies included in the systematic reviews
| Ref. | Study type | Sample size (M/F) | Mean/Median age | Disease duration (yr) | DXA equipment | DXA site | Coefficient variation BMD | Follow- up duration (yr) | Outcome | Conclusion |
| Florescu et al[19] | CS | RA: 10 HC: 10 | 63 | 15.3 | Norland | MC bones (II-V) | 0.9%-3.0% | There was a significant correlation between hand BMD and radiographic scoring methods | Hand BMD measurement may be a useful method for the detection and monitor of disease progression | |
| Peel et al[34] | CS | RA: 70 F | 64 | 3-45 | WH, LS, femoral neck | Increased bone loss in patients with RA vs controls Hands: 22.7% Lumbar spine: 10.7% Femoral neck: 16.3% Total body: 11.3% | Significant correlation between hand BMD and BMD at other sites. Hand BMD correlated with grip strength and inversely related to ESR in patients with early RA | |||
| Deodhar et al[13] | CS | RA: 56 (22/34) Controls: 95 (46/49) | M: 64 F: 64 | 9 | Hologic | WH | 1%-3% | Mean total hand BMC (grams, M/F) RA: 81.7 /52.3 Controls: 90.9/62.2 | Hand BMC correlated with disease severity but not with disease activity | |
| Devlin et al[3] | CS | RA: 202 (61/141) | M: 59 F: 53 | M: 1.6 F: 1.9 | Lunar | LS Hip WH | 0.6% | Hand BMD correlated with disease activity, functional capacity, lumbar and hip BMD | Hand bone loss can be used as outcome measure | |
| Njeh et al[30] | CS | RA: 51 F Patients with osteopenia: 44 F HC: 52 F | Mean age 57.5 | Lunar DPX-L | LS, Hip, WH | Mean Hand BMD (g/cm2) in patients with RA: 0.415 | Hand BMD was correlated with phalangeal ultrasound and hand functions but not CRP or ESR | |||
| Ozgocmen et al[22] | CS | RA: 30 F HC: 29 F | 45.5 | Lunar | WH II MC LS Hip | - | CI and C: MC ratio correlated with II. MC midshaft and hand BMD | CI may predict cortical bone mass of the hand. C: MC ratio is a useful method for evaluating progression of wrist involvement | ||
| Alenfeld et al[14] | CS | RA: 41 (18/23) HC: 103 (35/68) | 54 | F: 2.1 M: 2 | Lunar | WH Subcondral ROI | WH: 0.9 subcondral region: 2.7%-3.2% | Hand bone loss in the subregional regions is higher than total hand BMD | In early RA periarticular osteoporosis may be better assessed using detailed hand scan analyses | |
| Ardicoglu et al[18] | CS | RA: 49 (9/40) HC: 34 (5/29) | 49.1 | 5 | Lunar | LS Hip WH | Hand BMD correlated with disease duration, CRP and radiographic scores | Hand BMD by DXA is a useful pratical and reproducible method | ||
| Harrison et al[20] | CS | RA: 17 (4/13) PsA: 15 (9/6) | RA:51 PsA:53 | RA: 31 PsA: 27 | Hologic | MCP, PIP, DIP joints | 3.4%-6.6% | Periarticular BMD was significantly lower in patient with RA than PsA Periarticular BMD correlated with the number of swollen, tender joints in RA | Periarticular osteoporosis is associated with joint inflammation in RA but not PsA | |
| Ozgocmen et al[47] | CS | RA: 15 F HS: 3 F | 48.5 | 6.8 | Lunar | WH, MCP | - | Flow patterns correlated with intra-articular bone and cartilage destruction | PDUS is a useful method for monitoring disease activity and measurement of therapeutic response | |
| Jensen et al[48] | CS | RA: 11 female | 53 | Hologic | MC bones, forearm | 0.65%-0.83% | There was a significant association between DXA-BMD and DXR-BMD | Periarticular bone loss can be detected better and earlier with DXR than DXA in patients with RA | ||
| Castañeda et al[15] | CS | EA: 22 (2/20) HC: 16 (3/13) | EA: 48.4 HC: 49.2 | 0.4 | Hologic | WH MCP | MCP: 1.3% -0.7% WH: 1.4 %-0.9% | Whole hand BMD: (g/cm2) HC: 0.355 EA: 0.349 MCP BMD: (g/cm2) HS: 0.295, EA: 0.285 | Measurement of BMD at MCP joints may be a useful method to assess the diagnosis or prognosis in patients with EA | |
| Franck et al[21] | CS | RA: 421 (64/357) HC: 98 (31/67) | M: 56.11 F: 58.4 | M: 4.8 F: 4.8 | Hologic | LS, hip, forearm, WH, MCP II-III | Subregional scans: 0.9%-1.4% for short term, 1.5%-2.3% for mid-term | There was a significant correlation between WH BMD and its subregions, hip and forearm. Subregional BMD was correlated with CRP, bone resorption markers and grip strength | Measurement of hand and subregional BMD by DXA is accurate and reproducible method in RA | |
| Murphy et al[49] | CS | RA: 4 SpA: 3 | 36.7 | 1.25 | Hologic | MCP/PIP | 0.73%-0.78% | The precision of MCP joints was greater than PIP joints | DXA can be used as a reliable measure for periarticular BMD | |
| Alves et al[16] | CS | Established RA: 25 EA: 25 HS: 37 | Established RA: 53 Early arthritis: 52 | Lunar | WH, LS, hip, MCP and/or PIP joints mid MC to mid-phalangeal | 0.45%-1.07% | Mean BMD of five ROI: Established RA: 0.321 to 0.372 Early arthritis: 0.321 to 0.382 HC: 0.342 to 0.401 Mean BMD of whole hand: Established RA: 0.387 Early arthritis: 0.392 HC: 0.420 | Measurement of periarticular BMD is not a useful tool to discriminate between patients with early RA from HC | ||
| Zhu et al[7] | CS | RA: 100 F | 53.4 | 9.1 | Hologic | LS, hip, ultradistal radius | BMD assessed by HR-pQCT significantly correlated wth BMD at the peripheral and central skeleton | HR-pQCT is a useful method for evaluating periarticular bone loss at both cortical and trabecular bone | ||
| Moon et al[17] | CS | RA: 45 HC: 106 | 47.5 | Lunar | Shaft and periarticular region of PIP, LS, hip | The ratio of shaft to periarticular BMD was higher in patients with RA | DXA assisted localized quantification and BMD ratio calculations are useful for assessing periarticular osteoporosis in early RA | |||
| Dogu et al[33] | CS | RA: 83 | 52.9 | 6.99 | Lunar | WH | - | Hand BMD was correlated with HGS, TTP, radiological erosions but not DHI | HGS and TTP were most effective indicator of hand function | |
| Deodhar et al[10] | LS | RA: 81 (33/48) HC: 95 (46/49) | Early RA: M: 53, F: 55 Late RA M: 65.5, F: 63 | Early RA: 0.8 Late RA: 9 | Hologic | WH | 1 | After 1 yr hand bone loss Early RA: M: 3.25%, F: 1.46% Late RA, no significant loss of hand BMD | Hand bone loss was highest in patients with early RA and correlated with disease activity | |
| Daragon et al[25] | LS | Early RA: 15 (6/9) Other rheumatic diseases: 15 (7/8) | Early RA:42.7 Other rheumatic diseases: 48.8 | 0.4 | Hologic | WH | 1 | There was no significant correlation between hand bone loss and clinical, radiological and biological parameters except for IFN alfa | Hand BMD by DXA may be useful tool for the early classification of inflammatory disease | |
| Deodhar et al[26] | LS | Early RA: 40 | - | < 2 | Hologic | WH | 2.3% | 5 | Percent change in BMD after 1 yr: -5.5, 2 yr: -7.5, 3 yr: -9.8, 4 yr: -9.9, and 5 yr: -10 | Early loss in hand BMD (in the first six months) may be a prognostic marker for disease activity, functional status or poor functional outcome |
| Berglin et al[31] | LS | RA: 43(13/30) | Not available | 0.6 | Lunar | WH | 2 | Hand bone loss correlated with radiographic progression | Hand bone loss and radiographic progression were retarded by early treatment | |
| Jensen et al[24] | LS | RA: 51 (10/41) Unclassified polyarthritis: 21 (3/18) | RA: 54 Unclassifiesd polyarthritis: 39 | 0.3 | Norland | MCP, forearm | 2 | Hand BMD decreased only in patients with RA and associated with disease activity | DXR is better than DXA for detecting and monitoring periarticular osteoporosis of the MC bones | |
| Haugeberg et al[4] | LS | Undifferentiated arthritis: 74 (9/65) | 65 | 0.5 | Lunar | LS Hip | 1.07% | 1 | At the 1 yr follow-up, hand BMD loss; RA: -4.27 Inflammatory non-rheumatoid group: -0.49 Non-inflammatory group: -0.87 | Hand DXA may be useful for determining the risk of progressive disease in RA |
| Haugeberg et al[36] | LS | RA: 79 (32/47) | 49.7 | 0.7 | Lunar | WH | 0.9 | Mean hand BMD loss 2.5% at 24 wk, 2.6% at 48 wk | Hand DXA is more sensitive than radiology can be used as outcome measure in early RA | |
| Murphy et al[23] | LS | RA: 20 (8/12) SpA: 18 (11/7) | RA: 37, SpA: 33 | RA: 0.4 SpA: 0.4 | Hologic | WH LS Hip | 1 | Periarticular bone loss correlated with radiographic damage, disease activity and baseline TIMP-1 level | TIMP-1 may be use as a biomarker of periarticular bone loss in early RA | |
| Hill et al[27] | LS | RA: 50 (12/38) Control: 30 | 57 | 0.75 | Lunar | WH, LS, hip | 1.1% | 1 | Hand BMD correlated with baseline CRP and radiographic score in RA | Hand BMD using DXA is a safe, reproducible procedure. It may predict radiological progression and disease activity |
| Bejarano et al[35] | LS | RA: 64 (27/37) | 54.1 | 0.5 | WH, lumbar spine, hip | 6.4 yr | Follow-up change in hand BMD, -0.034 | First year hand BMD loss was not associated with function or quality of life status but not long-term radiographic progression | ||
| Naumann et al[28] | LS | Early RA: 17 (4/13) Established RA: 35 (8/27) | Early RA: 55, Established RA with moderate disease activity: 58 Established RA with high disease activity: 53.5 | Early RA: 0.2 | Lunar | WH, MCP/ PIP, wrist, LS hip | Wrist: 0.75 WH: 0.78 | 1 | There was a negative correlation between hand BMD and MCP joint synovitis in patients with high diasease activity. The best precision values of BMD were found for the wrist | Hand BMD measurement by DXA is highly reproducible method in patients with RA |
| Black et al[37] | LS | RA: 106 (29/77) | 57 | 0.3 | Lunar | WH | 1 | Lower hand BMD was associated with higher erosion scores | Hand BMD loss in the first 6 mo can predict early erosive change in patients with early RA | |
| Haueberg et al[38] | IS | RA: 20 (7/13) IFX + MTX: 10 | 52.2 | < 1 | Lunar | WH, LS, hip | 1 | BMD (gr/cm2) IFX treated group: WH: 0.42, spine: 1.14, T hip: 1.04, F neck: 1.03 Placebo: WH: 0.43, spine: 1.28, T hip: 1.06, F neck: 1.01 | In the IFX treated group hand bone loss arrested at the hip but not at the hand and lumbar spine | |
| Deodhar et al[39] | IS | Placebo: 13 Denosumab 60 mg treated group: 21 (7/14) Denasumab 180 mg treated group: 22 (5/17) | Placebo: 55.2 Denosumab 60 mg treated group: 57.7 Denasumab 180 mg treated group: 58.7 | Placebo: 10.3 Denosumab 60 mg treated group: 12.6 Denasumab 180 mg treated group: 15.8 | Lunar | WH | 1 | Mean change in hand BMD at 6/12 mo (%); denosumab 60 mg: 0.8/1 Denosumab 180 mg: 2/ 2.5 placebo: -1.2/-2 | Denosumab increased hand BMD and decreased progression of bone erosion in RA | |
| Haugeberg et al[29] | IS | MTX group: 19 (10/9) MTX + IAST: 21 (8/13) | MTX group: 56.2 MTX + IAST: 53.3 | MTX group: 0.5 MTX + IAST: 0.4 | Lunar | WH, MCP, hip, LS | 1 | In the first 3 mo, hand bone loss was lower in MTX + IAST treated group than MTX treated group. Hand bone loss associated disease activity, hand function and MRI synovitis score | IAST may protect against periarticular bone loss in inflamed finger joints in RA | |
| Szentpetery et al[32] | IS | RA: 35 (11/24) PsA: 27 (12/15) | RA: 56 PsA: 44 | RA: 8 PsA: 7 | Hologic | WH, PIP/MCP, hip, LS | 3 | Following anti- TNF therapy hip BMD decreased but spine and hand BMD unchanged. Periarticular BMD around PIP joints increased, MCP decreased | Anti TNF therapy increased bone formation without a change in bone resorption |
CS: Cross-sectional study; CI: Cortical index; MC: Carpo:metacarpal; EA: Early arthritis; DXR: Digital X ray radiogrammetry; DXA: Dual X ray absorptiometry; HR-pQCT: High-resolution peripheral quantitative computed tomography; HGS: Handgrip strength; IAST: Intra-articular corticosteroid; HC: Healthy controls; IS: Interventional study; LS: Longitudinal study; PsA: Psoriatic arthritis; ROI: Region of interest; RA: Rheumatoid arthritis; SpA: Spondiloartropathy; TIMP-1: Tissue inhibitor of metalloproteinases 1; TTP: Three-finger pinch; vBMD: Trabecular volumetric bone mineral density; WH: Whole hand; LS: Lumbar spine; BMC: Bone mineral content; BMD: Bone mineral density; EA: Early arthritis; MTX: Methotrexate.