Bone Abstracts

Background: Several short-term studies have been performed in rheumatoid arthritis (RA) reporting a rapid rate of generalized bone loss. Aggressive anti-inflammatory treatment with biologic disease modifying anti-rheumatic drugs (DMARDs) has been shown to reduce the rate of bone loss¹. There is a lack of long term follow-up studies.

Objectives: To study 10-year changes in generalized bone loss in early RA patients in the biologic treatment era.

Methods: Between 1999 and 2001, 93 RA patients fulfilling the ACR RA criteria (disease duration <1 year) were included in a long term observational study. Demographic and clinical data was collected. Bone mineral density (BMD) measurements at lumbar spine and hip (femoral neck and total hip) were performed using the same dual energy x-ray absorptiometry (DXA) equipment Lunar Prodigy (General Electric) at baseline and after 2, 5, and 10 years.

Results: Patient characteristics at baseline: mean (S.D.) age 50.4 (13.6) years, females 61.7%, RF +62.8%, CCP +60.6%, and erosive 2.1%. Baseline disease characteristics: swollen, 28 joints 8.4; tender, 28 joints 9.7, MHAQ 0.68; ESR 29.2 mm/h; and CRP 28.9 mg/dl. Ever use of prednisolone 73.4%, synthetic DMARDs 93.6% and biologic DMARDs 53.2%.

Rate of bone loss at 2, 5 and 10 years is shown in the table. At femoral neck and total hip bone loss was linear with average annual bone loss of 0.64% at femoral neck and 0.49% at total hip.

Conclusions: Our data indicate that aggressive anti inflammatory treatment protects against bone loss at spine whereas bone loss continues at the hip. However interestingly the rate of bone loss is at the same rate as reported in the general population².

Reference: 1. Haugeberg et al. ARD 68 1898–1901, 2009.

2. Warming et al. Osteop. Int 13 105–12.