- Email: [email protected]
Evaluation of Bone Loss in Rheumatoid Arthritis
Abstracts
439
in men with LBMD compared to men with NBMD. Although family history of osteoporosis did not differ between men with low and normal BMD, personal fracture history was significantly higher in men with LBMD (p50.01). Men self-reported performing on average 17.8 hours of moderate physical activity per wk and those with low BMD were found to have even greater moderate physical activity, reporting 20.1 hours above national recommendations. Conclusion: Serious leisure trained male cyclists exhibit a range of subclinical alterations in BMD in the absence of concomitant changes in gonadotropin levels. The osteopenic men in this study were performing regular exercise, had normal BMI’s appear to be fit and yet they are at a serious risk for osteopenic fractures. It is possible that the excess physical activity without weight-bearing characteristics observed in this cohort of cyclists is a risk factor for osteopenia and may lead to an increased incidence of fracture. The possibility remains that unknown factors confound the association between BMD in this cohort which require further investigation.
for-age Z-score (HAZ) at a median of 2.2 yr after HCT. Risk factors assessed included sex, age at HCT, BMI Z-score, lean body mass, vitamin D deficiency, hypothyroidism, and hypogonadism. Statistical analyses used GEE. Results: FA patients were shorter than controls (mean height Z-score -1.9 1.4 vs -0.4 1.0, p!0.0001), had lower mean TBMDHAZ Z-score, and a higher prevalence of TBMDHAZ Z-score !-1 (Table 1). While mean LBMD Z-score was lower in FA patients than controls, there was no significant difference after adjusting for height. In FA patients, no risk factor was significantly associated with TBMD deficit and only lower BMI Z-score was associated with lower LBMD Z-scores. Conclusions: FA patients, mostly under 18 yr at DXA, had BMD deficits for total body but not the lumbar region. This suggests cortical bone is affected more in FA patients than trabecular bone. Lack of clear association between TBMD deficits and risk factors suggests bone loss is intrinsic to FA, though our study design does not allow separate estimation of HCT’s effect and further studies need to be conducted to address this question.
P41 Low Bone Mass Density is Associated with Hemolysis in Brazilian Patients with Sickle Cell Disease
Table 1
Mariana Ribeiero; University of Campinas Allan Oliveira Santos, Gabriel Baldanzi, Jose Francisco Marques Neto, Celso Dario Ramos, Sara Saad Introduction: Bone involvement is a frequent clinical manifestation of sickle cell disease (SCD), and it has multiple causes; however, there are few consistent clinical associations between bone mineral involvement and sickle cell disease. Objectives: To determine whether kidney disease and hemolysis are associated with bone mass density (BMD) in a population of adult Brazilian patients with sickle cell disease. Methods: Patients older than 20 years of age with SCD who were regularly followed at our institution were divided into three groups. One including those with normal bone mass density and the others, including those with osteopenia, and those with osteoporosis, according to the World Health Organization criteria. The clinical data of the patients were compared with bone mineral density status using statistical analyses. Results: Sixty-five patients were included with a median age of 32.5 years: 12 of them (18.5%) with normal BMD, 37 (57%) with osteopenia and the remainder 16 (24.5%) with osteoporosis. Overall, 53 patients (81.5%) had BMD below normal parameters. Osteopenia and osteoporosis patients had increased lactate dehydrogenase levels and reticulocyte counts compared to patients with normal bone mass density (p!0.05). Osteoporosis patients also had decreased hemoglobin levels (p!0.05). Hemolysis was significantly increased in patients with osteoporosis compared with patients with osteopenia, as indicated by increased lactate dehydrogenase levels and reticulocyte counts as well as decreased hemoglobin levels. Osteoporosis patients were older, with lower glomerular filtration rates than patients with osteopenia. There was no significant difference between the groups with regard to gender, body mass index, serum creatinine levels, estimated creatinine clearance or microalbuminuria. Conclusion: A high prevalence of reduced bone mass density that was associated with hemolysis was found in this population, as indicated by the high lactate dehydrogenase levels, increased reticulocyte counts and low hemoglobin levels. With the increase of life expectancy in pacients with SCD, osteoporosis may become a major public health problem in this population and therefore, patients with SCD should have BMD monitored, specially those that according to this study show intense hemolysis.
P42 Bone Mineral Density in Children and Young Adults with Fanconi Anemia after Hematopoietic Cell Transplantation Anna Petryk; University of Minnesota Lynda Polgreen, Scott Baker, John Wagner, Julia Steinberger, Margaret MacMillan Background: Fanconi anemia (FA) is an inherited DNA repair disorder associated with short stature, congenital anomalies, high risk for malignancy and bone marrow failure requiring hematopoietic cell transplant (HCT). While low bone mineral density (BMD) has been reported in leukemia patients after HCT, little is known about BMD in FA patients after HCT. This study goals were to 1) determine if FA patients treated with HCT have lower BMD than healthy controls, and 2) test for association between BMD and risk factors for bone loss. We hypothesized: 1) mean BMD Z-score is lower in FA HCT recipients; 2) hypogonadism and vitamin D deficiency are associated with lower BMD Z-score. Methods: Cross-sectional study of 38 FA patients (20 male) transplanted using the same radiation-based regimen from 2006-2013, and 208 healthy controls (112 male), mean age at study 12.8 5.1 yr (range 6.5-27.8) and 13.6 2.4 yr (range 9-18), respectively. FA patients underwent HCT at mean age 10.0 5.3 yr. BMD Z-scores for total body (TBMD) and lumbar spine (LBMD) were measured by dual energy x-ray absorptiometry (DXA), with and without adjusting for height-
Outcome
Controls (N5208)
FA (N538)
P
0.6 0.9 0.0 0.9 6 (3) 21 (10)
-1.3 1.0 -1.0 0.8 26 (70) 19 (54)
!0.0001 !0.0001 !0.0001 !0.0001
TBMDage Z-score (mean ± SD) TBMDHAZ Z-score (mean ± SD) TBMDage Z-score -1, n (%) TBMDHAZ Z-score -1, n (%)
P43
Evaluation of Bone Loss in Rheumatoid Arthritis
Sweta Boban; Cornell University Lisa Francis (CHI St. Alexius Health), Boban Matthew Background: Generalized bone loss has been demonstrated in rheumatoid arthritis in several observational and some longitudinal studies using bone densitometry. Rheumatoid arthritis is an independent risk factor for development of osteoporosis in the FRAX score which is the WHO Fracture Risk Assessment tool. However, most of these studies were conducted prior to the widespread use of biological agents and adequate control of disease activity has been postulated to reduce progressive bone loss. We evaluated the bone density in a rheumatoid arthritis cohort in whom biological agents have been used for aggressive control of rheumatoid arthritis according to the current American College of Rheumatology guidelines. Methods: We conducted a retrospective review of rheumatoid arthritis patients evaluated in a rheumatology clinic during a 12 month period from Jan 2013Jan 2014. 112 postmenopausal females with age more than 50 years had bone density evaluation done. Bone density evaluation was done in these patients using central DXA scan using a Hologic or GE machine. Osteopenia was defined as a T score between -1.0 and -2.5. Osteoporosis was defined as a T score of !2.5. The results were compared to the National Osteoporosis Risk Assessment (NORA) study which is the largest study of bone density evaluation done in ambulatory postmenopausal women aged 50 years or older who served as the control population. The results were compared using statistical analysis using the chi-square test. Analysis was performed with Statistics calculator from StatPac Inc. Results: 112 postmenopausal females with rheumatoid arthritis aged 50 or older had bone density evaluation, out of which 84 (75%) patients were diagnosed to have bone loss using the DXA scan. In the NORA study 93675 (46.8%) patients had bone loss among the 200160 patients who were studied. There was a significant increase in bone loss in postmenopausal women O50 years with rheumatoid arthritis (p value !0.00001) compared to normal postmenopausal women aged 50 years or older in the NORA study which was used as the control population. Conclusion: Rheumatoid arthritis continues to be a significant risk factor for development of bone loss even with the widespread use of biological agents. It is important to obtain bone density evaluation in all postmenopausal women with rheumatoid arthritis in order to encourage measures to prevent bone loss in these patients.
Table 1. Comparison between RA study and NORA
Postmenopausal women O50 osteopenia osteoporosis Osteopenia +osteoporosis
Journal of Clinical Densitometry: Assessment & Management of Musculoskeletal Health
RA study
percentage
NORA
percentage
112 52 32 84
46.4 28.57 75
200160 79263 14412 93675
39.6 7.2 46.8
Volume 18, 2015
439
in men with LBMD compared to men with NBMD. Although family history of osteoporosis did not differ between men with low and normal BMD, personal fracture history was significantly higher in men with LBMD (p50.01). Men self-reported performing on average 17.8 hours of moderate physical activity per wk and those with low BMD were found to have even greater moderate physical activity, reporting 20.1 hours above national recommendations. Conclusion: Serious leisure trained male cyclists exhibit a range of subclinical alterations in BMD in the absence of concomitant changes in gonadotropin levels. The osteopenic men in this study were performing regular exercise, had normal BMI’s appear to be fit and yet they are at a serious risk for osteopenic fractures. It is possible that the excess physical activity without weight-bearing characteristics observed in this cohort of cyclists is a risk factor for osteopenia and may lead to an increased incidence of fracture. The possibility remains that unknown factors confound the association between BMD in this cohort which require further investigation.
for-age Z-score (HAZ) at a median of 2.2 yr after HCT. Risk factors assessed included sex, age at HCT, BMI Z-score, lean body mass, vitamin D deficiency, hypothyroidism, and hypogonadism. Statistical analyses used GEE. Results: FA patients were shorter than controls (mean height Z-score -1.9 1.4 vs -0.4 1.0, p!0.0001), had lower mean TBMDHAZ Z-score, and a higher prevalence of TBMDHAZ Z-score !-1 (Table 1). While mean LBMD Z-score was lower in FA patients than controls, there was no significant difference after adjusting for height. In FA patients, no risk factor was significantly associated with TBMD deficit and only lower BMI Z-score was associated with lower LBMD Z-scores. Conclusions: FA patients, mostly under 18 yr at DXA, had BMD deficits for total body but not the lumbar region. This suggests cortical bone is affected more in FA patients than trabecular bone. Lack of clear association between TBMD deficits and risk factors suggests bone loss is intrinsic to FA, though our study design does not allow separate estimation of HCT’s effect and further studies need to be conducted to address this question.
P41 Low Bone Mass Density is Associated with Hemolysis in Brazilian Patients with Sickle Cell Disease
Table 1
Mariana Ribeiero; University of Campinas Allan Oliveira Santos, Gabriel Baldanzi, Jose Francisco Marques Neto, Celso Dario Ramos, Sara Saad Introduction: Bone involvement is a frequent clinical manifestation of sickle cell disease (SCD), and it has multiple causes; however, there are few consistent clinical associations between bone mineral involvement and sickle cell disease. Objectives: To determine whether kidney disease and hemolysis are associated with bone mass density (BMD) in a population of adult Brazilian patients with sickle cell disease. Methods: Patients older than 20 years of age with SCD who were regularly followed at our institution were divided into three groups. One including those with normal bone mass density and the others, including those with osteopenia, and those with osteoporosis, according to the World Health Organization criteria. The clinical data of the patients were compared with bone mineral density status using statistical analyses. Results: Sixty-five patients were included with a median age of 32.5 years: 12 of them (18.5%) with normal BMD, 37 (57%) with osteopenia and the remainder 16 (24.5%) with osteoporosis. Overall, 53 patients (81.5%) had BMD below normal parameters. Osteopenia and osteoporosis patients had increased lactate dehydrogenase levels and reticulocyte counts compared to patients with normal bone mass density (p!0.05). Osteoporosis patients also had decreased hemoglobin levels (p!0.05). Hemolysis was significantly increased in patients with osteoporosis compared with patients with osteopenia, as indicated by increased lactate dehydrogenase levels and reticulocyte counts as well as decreased hemoglobin levels. Osteoporosis patients were older, with lower glomerular filtration rates than patients with osteopenia. There was no significant difference between the groups with regard to gender, body mass index, serum creatinine levels, estimated creatinine clearance or microalbuminuria. Conclusion: A high prevalence of reduced bone mass density that was associated with hemolysis was found in this population, as indicated by the high lactate dehydrogenase levels, increased reticulocyte counts and low hemoglobin levels. With the increase of life expectancy in pacients with SCD, osteoporosis may become a major public health problem in this population and therefore, patients with SCD should have BMD monitored, specially those that according to this study show intense hemolysis.
P42 Bone Mineral Density in Children and Young Adults with Fanconi Anemia after Hematopoietic Cell Transplantation Anna Petryk; University of Minnesota Lynda Polgreen, Scott Baker, John Wagner, Julia Steinberger, Margaret MacMillan Background: Fanconi anemia (FA) is an inherited DNA repair disorder associated with short stature, congenital anomalies, high risk for malignancy and bone marrow failure requiring hematopoietic cell transplant (HCT). While low bone mineral density (BMD) has been reported in leukemia patients after HCT, little is known about BMD in FA patients after HCT. This study goals were to 1) determine if FA patients treated with HCT have lower BMD than healthy controls, and 2) test for association between BMD and risk factors for bone loss. We hypothesized: 1) mean BMD Z-score is lower in FA HCT recipients; 2) hypogonadism and vitamin D deficiency are associated with lower BMD Z-score. Methods: Cross-sectional study of 38 FA patients (20 male) transplanted using the same radiation-based regimen from 2006-2013, and 208 healthy controls (112 male), mean age at study 12.8 5.1 yr (range 6.5-27.8) and 13.6 2.4 yr (range 9-18), respectively. FA patients underwent HCT at mean age 10.0 5.3 yr. BMD Z-scores for total body (TBMD) and lumbar spine (LBMD) were measured by dual energy x-ray absorptiometry (DXA), with and without adjusting for height-
Outcome
Controls (N5208)
FA (N538)
P
0.6 0.9 0.0 0.9 6 (3) 21 (10)
-1.3 1.0 -1.0 0.8 26 (70) 19 (54)
!0.0001 !0.0001 !0.0001 !0.0001
TBMDage Z-score (mean ± SD) TBMDHAZ Z-score (mean ± SD) TBMDage Z-score -1, n (%) TBMDHAZ Z-score -1, n (%)
P43
Evaluation of Bone Loss in Rheumatoid Arthritis
Sweta Boban; Cornell University Lisa Francis (CHI St. Alexius Health), Boban Matthew Background: Generalized bone loss has been demonstrated in rheumatoid arthritis in several observational and some longitudinal studies using bone densitometry. Rheumatoid arthritis is an independent risk factor for development of osteoporosis in the FRAX score which is the WHO Fracture Risk Assessment tool. However, most of these studies were conducted prior to the widespread use of biological agents and adequate control of disease activity has been postulated to reduce progressive bone loss. We evaluated the bone density in a rheumatoid arthritis cohort in whom biological agents have been used for aggressive control of rheumatoid arthritis according to the current American College of Rheumatology guidelines. Methods: We conducted a retrospective review of rheumatoid arthritis patients evaluated in a rheumatology clinic during a 12 month period from Jan 2013Jan 2014. 112 postmenopausal females with age more than 50 years had bone density evaluation done. Bone density evaluation was done in these patients using central DXA scan using a Hologic or GE machine. Osteopenia was defined as a T score between -1.0 and -2.5. Osteoporosis was defined as a T score of !2.5. The results were compared to the National Osteoporosis Risk Assessment (NORA) study which is the largest study of bone density evaluation done in ambulatory postmenopausal women aged 50 years or older who served as the control population. The results were compared using statistical analysis using the chi-square test. Analysis was performed with Statistics calculator from StatPac Inc. Results: 112 postmenopausal females with rheumatoid arthritis aged 50 or older had bone density evaluation, out of which 84 (75%) patients were diagnosed to have bone loss using the DXA scan. In the NORA study 93675 (46.8%) patients had bone loss among the 200160 patients who were studied. There was a significant increase in bone loss in postmenopausal women O50 years with rheumatoid arthritis (p value !0.00001) compared to normal postmenopausal women aged 50 years or older in the NORA study which was used as the control population. Conclusion: Rheumatoid arthritis continues to be a significant risk factor for development of bone loss even with the widespread use of biological agents. It is important to obtain bone density evaluation in all postmenopausal women with rheumatoid arthritis in order to encourage measures to prevent bone loss in these patients.
Table 1. Comparison between RA study and NORA
Postmenopausal women O50 osteopenia osteoporosis Osteopenia +osteoporosis
Journal of Clinical Densitometry: Assessment & Management of Musculoskeletal Health
RA study
percentage
NORA
percentage
112 52 32 84
46.4 28.57 75
200160 79263 14412 93675
39.6 7.2 46.8
Volume 18, 2015