Decreased bone mineral density in pre-menopause women with prolactinoma

Tumoral hyperprolactinemia and consequent hypogonadism have been associated with osteoporosis. Bone mineral density (BMD) was measured by dual-energy RX absorptiometry in 24 patients with prolactinoma (15 macro and 9 micro adenomas; age range = 18 to 49 years). Student unpaired t or Mann-Whitney tests were used to compare groups, and Spearman test studied correlations. Lumbar spine (LS) was the most affected, as LS Z-score was < -2 SD in 20.83% of the patients. No difference was found in densitometric parameters for the comparison between macro and microprolactinoma, or those with normal prolactin versus hyperprolactinemia. LS BMD and LS Z-score were higher in the patients with > 8 menstrual cycles in the preceding year then in those with oligoamenorrhea (p = 0.030). The number of cycles was correlated to LS BMD (r = 0.515, p = 0.017) and body mass index to femoral neck BMD (r = 0.563, p = 0.006) and total femur BMD (r = 0.529, p = 0.011). CONCLUSIONS: Decreased bone mineral density was detected in 20.83% of our young patients with prolactinoma. The great involvement of trabecular bone skeletal regions, such as vertebrae, suggests the participation of hypogonadism in the pathogenesis of bone disease. Irrespective of prolactin levels, return to normal menses seems the best index of good control.     

Calcaneus bone mineral density in Japanese women with rheumatoid arthritis

Objectives The aim of this study was to investigate the relationships among bone mineral densities (BMD) in the calcaneus and leg activity of daily living (L-ADL) in rheumatoid arthritis (RA) patients.Methods We measured and compared calcaneus BMD using single X-ray absorptiometry and lumbar spine and femoral neck BMD using dual X-ray absorptiometry in 158 Japanese female outpatients with RA and 358 normal controls (NC).Results Regardless of whether the women were premenopausal or postmenopausal, calcaneus and femoral neck BMDs in the RA group were significantly lower than in the NC group. Calcaneus BMD correlated with the modified health assessment questionnaire, L-ADL score, and 10-m walking time, regardless of whether the patients were premenopausal or postmenopausal (P<0.01).Conclusions We conclude that calcaneus BMD reflects the L-ADL of RA patients very well and allows us to perform the same level of BMD evaluation as that with current BMD measurement methods.     

Evaluation of bone mineral density in women with chronic liver diseases during perimenopausal period

Osteoporosis is the most frequently occurring metabolic diseases of bones, observed especially in women after menopause. The goal of the paper was a comparison of bone mineral density (BMD) of health women with that in perimenopausal patients with chronic liver diseases. The study was performed in 47 patients with chronic liver diseases, aged: 37-56 years. Qualification criteria included chronic type B hepatitis, chronic type C hepatitis and cirrhosis of viral aetiology. The control group consisted of 15 healthy, age-matched women. All the women had been examined in order to identify other risk factors of osteoporosis development. RESULTS: The incidence of decreased BMD was statistically higher in the group of patients with chronic hepatic diseases, compared to the group of healthy subjects. No bone fracture was found in any of the examined patients. CONCLUSIONS: Routine densitometric examinations should be performed in all women in perimenopausal age with chronic liver diseases. Results of our studies indicate that in patients with liver diseases, the lowest BMD values are found in the group of patients with cirrhosis or chronic type C hepatitis. These women constitute a large risk group for secondary osteoporosis development.     

The study of bone mineral density and bone turnover markers in postmenopausal women with active rheumatoid arthritis

Abstract

The aim of this study was to investigate determinants of reduced bone mineral density (BMD) in postmenopausal women with active rheumatoid arthritis (RA) and to evaluate whether there are common markers of bone loss. We evaluated BMD of the femoral neck using dual-energy X-ray absorptiometry, and the measured biochemical markers included serum bone-specific alkaline phosphatase (BALP), serum osteocalcin (OC), and serum cross-linked N-telopeptidases of type I collagen (NTx). Serum BALP and NTx concentrations were measured by enzyme-linked immunsorbent assay, and OC was measured using an immunoradiometric assay. One hundred and forty postmenopausal Japanese women who had not received treatment with bisphosphonates or hormone replacement therapy were entered into the study. Thirty-four patients (41.0%) had femoral osteopenia (T score ?1 to ?2.5) and 23 patients (27.7%) had osteoporosis (T < ?2.5). The body mass index of patients with normal BMD (T score ≥ ?1.0) was significantly higher (P < 0.01) than in patients with osteoporosis at the femoral neck. The T score exhibited a significant negative correlation with age and the duration of RA disease. Serum BALP and serum OC, markers of osteoblast function, were negatively related to erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and matrix metalloproteinase-3 (MMP-3). However, serum NTx, a marker of resorptive function, exhibited a positive correlation with ESR, CRP, and MMP-3. From these results, this study suggests that generalized bone loss occurs in active RA and is characterized by evidence of bone resorption that is correlated with the high levels of inflammation. Body mass index, disease duration, and high serum NTx level were common risk factors in osteoporosis of postmenopausal women with RA.     

Adjuvant oestrogen treatment increases bone mineral density in postmenopausal women with rheumatoid arthritis.

OBJECTIVES--The beneficial effect of oestrogens on bone mineral density in women with osteoporosis is well known. Patients with rheumatoid arthritis (RA) are at risk for osteoporosis. A study was therefore set up to investigate the effects of adjuvant oestrogen treatment on bone metabolism and bone mineral density in postmenopausal women with RA. METHODS--Forty postmenopausal women with active RA were admitted to a placebo controlled, double blind study investigating the beneficial effect of adjuvant oestradiols or placebo on bone metabolism and bone mineral density. Thirty three patients completed 52 weeks of treatment. RESULTS--At the start both treatment groups were comparable for all parameters. In the oestrogen group serum concentrations of osteocalcin decreased and concentrations of sex hormone binding globulin increased during the study. Bone mineral density measured by dual energy x ray absorptiometry increased significantly in the lumbar vertebral spine and femoral neck in the oestrogen group compared with the placebo group. CONCLUSIONS--This study shows that the use of adjuvant oestrogens in post-menopausal women with active RA increases bone mineral density.     

The study of bone mineral density and bone turnover markers in postmenopausal women with active rheumatoid arthritis

The aim of this study was to investigate determinants of reduced bone mineral density (BMD) in postmenopausal women with active rheumatoid arthritis (RA) and to evaluate whether there are common markers of bone loss. We evaluated BMD of the femoral neck using dual-energy X-ray absorptiometry, and the measured biochemical markers included serum bone-specific alkaline phosphatase (BALP), serum osteocalcin (OC), and serum cross-linked N-telopeptidases of type I collagen (NTx). Serum BALP and NTx concentrations were measured by enzyme-linked immunsorbent assay, and OC was measured using an immunoradiometric assay. One hundred and forty postmenopausal Japanese women who had not received treatment with bisphosphonates or hormone replacement therapy were entered into the study. Thirty-four patients (41.0%) had femoral osteopenia (T score −1 to −2.5) and 23 patients (27.7%) had osteoporosis (T < −2.5). The body mass index of patients with normal BMD (T score ≥ −1.0) was significantly higher (P < 0.01) than in patients with osteoporosis at the femoral neck. The T score exhibited a significant negative correlation with age and the duration of RA disease. Serum BALP and serum OC, markers of osteoblast function, were negatively related to erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and matrix metalloproteinase-3 (MMP-3). However, serum NTx, a marker of resorptive function, exhibited a positive correlation with ESR, CRP, and MMP-3. From these results, this study suggests that generalized bone loss occurs in active RA and is characterized by evidence of bone resorption that is correlated with the high levels of inflammation. Body mass index, disease duration, and high serum NTx level were common risk factors in osteoporosis of postmenopausal women with RA.     

Bone mineral density in Indian women with rheumatoid arthritis

Osteoporosis (OP) is being increasingly recognized in inflammatory rheumatic diseases like rheumatoid arthritis (RA). Ethnicity influences bone mineral density (BMD) and fracture risk. Due to paucity of data on this aspect of RA from Asian countries including India, we prospectively studied 84 premenopausal women with RA of at least 2 years duration and 247 healthy, age (within 5 years) and sex-matched controls. A significant difference in BMD between patients and controls was observed only at the femoral neck. As many as 22% patients with RA exhibited osteoporosis at least one site in contrast to 9% controls. Nearly 40% of patients exhibited osteopenia at all the three sites. Modified Sharp score, disease duration and DMARD naive period were found to correlate with low BMD. However, on multivariate analysis, only modified Sharp score was shown to be significantly associated with low BMD. Our study draws attention to the poor bone health in Asian Indian women with RA.     

Association of apolipoprotein E polymorphism with bone mineral density in postmenopausal women with rheumatoid arthritis

SIR, Pathological bone loss can occur by marginal erosions,juxta-articular osteoporosis and generalized osteoporosis inrheumatoid arthritis (RA) [1]. Several studies demonstratedthat these different types of bone involvement are similarlymediated by receptor activator of nuclear factor B ligand (RANKL),a factor stimulating osteoclast differentiation [2, 3]. Therefore,generalized osteoporosis has been suggested as a risk factorfor severe joint destruction in RA. In fact, joint erosionsrelated to generalized osteoporosis and high Larsen scores associatedstrongly with bone mineral density (BMD) reduction have beenfound in patients with     

Relationship between body composition and bone mineral density (BMD) in perimenopausal Korean women

Objectives Osteoporosis is a disease that increases the fracture rates and it is the major cause of increased mortality and morbidity in the elderly people. To determine which component of body composition is most important to bone health, we analysed the relationship between elements of the body composition and bone mineral density (BMD) in Korean women. Design Cross‐sectional clinical study. Patients Totally 1694 women (mean age 51 years) were selected from subjects who participated in a medical check‐up program. Measurements Body composition analysis was performed by segmental bioelectric impedance method and lean mass, fat mass and per cent body fat measured. Waist : hip ratio (WHR) was assessed as a marker for visceral fat. Lumbar spine (l ‐spine) BMD was measured by dual X‐ray absorptiometry (DEXA). As menopausal status could not be confirmed in all subjects, we divided the subjects into two groups according to the age > 50 years and < 50 years. Results Among the entire population, 599 subjects (35·4%) were osteopaenic and 229 subjects (13·5%) were osteoporotic. The bivariate correlation among the variables showed that weight had the highest correlation with fat mass. Mean lean mass was decreased and the WHR increased as the subjects progressed from normal to osteoporotic status; fat mass was the highest among the osteopaenic subjects. l ‐spine BMD showed a positive correlation with lean mass, and a negative correlation with WHR by bivariate correlation analysis. However, fat mass had a negative correlation with l ‐spine BMD only after adjustment for age and weight. Multiple regression analysis with l ‐spine BMD as the dependent variable showed that age, height, fasting insulin, lean mass and WHR were significant determinants of the l ‐spine BMD (R² = 0·170, P < 0·05). Conclusion In this Korean female population, l ‐spine BMD showed a consistently positive correlation with lean mass and a negative correlation with WHR. Fat mass failed to show any consistent correlation with l ‐spine BMD in this study population.     

Depressed levels of dehydroepiandrosterone sulphate in postmenopausal women with rheumatoid arthritis but no relation with axial bone density.

The sex hormones dehydroepiandrosterone sulphate (DHEAS), oestradiol, and sex hormone binding globulin (SHBG) were measured in 185 postmenopausal women (aged 45-65 years) with rheumatoid arthritis (RA) and related to assessments of bone mineral density at the spine and proximal femur. Compared with 518 postmenopausal control women (aged 45-65 years), DHEAS levels were below normal in the 120 patients with RA who had never taken corticosteroids and levels were further depressed in 39 patients currently using steroids. Twenty six patients who had completed steroid treatment also had lower DHEAS levels, suggesting a delayed recovery of adrenal androgen secretion. Oestradiol and SHBG levels were similar in all groups. There was no correlation between sex hormones and disease activity. Oestradiol correlated with bone mineral density at all sites. Although oestradiol correlated with DHEAS, there was no relation between DHEAS and bone mineral density. The cause of below normal levels of DHEAS in RA is unclear, whether a consequence of chronic illness, immune dysfunction, or a defect of adrenal androgen synthesis.     

Elevation of only one rheumatoid factor isotype is not associated with increased prevalence of rheumatoid arthritis--a population based study

OBJECTIVE: To analyse the relationship between different rheumatoid factor (RF) isotype patterns and the prevalence of RA. METHODS: Serum samples, collected between 1973 and 1983 from nearly 14,000 randomly selected individuals, were screened for elevation of RF. In 1987, 173 RF positive and 156 matched RF negative participants were evaluated clinically. RESULTS: Participants with elevation of only one RF isotype, most commonly IgM, did not have significantly higher prevalence of RA than the RF negative controls. Of the 17 RF positive individuals who were diagnosed with RA, 14 (82%) had a combined elevation of IgM and IgA RF. CONCLUSION: In contrast to a combined elevation of IgM and IgA RF, elevation of only one RF isotype may not be a significant risk factor for the development of RA.     

The effect of circulating nitric oxide level on axial bone mineral density in postmenopausal Turkish women with rheumatoid arthritis: a preliminary report

The aim is to investigate the differences in the circulating nitric oxide (NO) levels of rheumatoid arthritis (RA) patients, healthy controls and osteoporotic (OP) patients. We also examined whether the circulating NO levels may be correlated with bone mineral density (BMD) in RA patients. Forty-five patients with RA, 30 healthy women and 30 osteoporotic patients were recruited from the outpatient clinic. All the subjects were female and postmenopausal. Serum NO levels were measured (Nitrite/Nitrate, calorimetric method 1746081, Roche diagnostics, Mannheim, Germany) and BMD was measured at the spine and hip using dual energy X-Ray absorbtiometry (DEXA, Norland XR-46). Height and weight were measured and body mass index was calculated. Circulating NO levels were significantly higher in RA patients than other groups. Moreover, the RA group showed significantly higher BMD at lumbar spine and femoral neck regions compared to osteoporotic patients. However, the RA group showed significantly lower BMD at all sites than the controls. There was no correlation between circulating NO levels and BMD in all groups. We suggest that, unlike postmenopausal osteoporosis, inflammation induced osteoporosis is associated with RA is characterised by relatively preserved bone mass at the axial bone regions, and circulating NO levels as a parameter or determinant of inflammation are not correlated with axial BMD in RA patients.     

类风湿性关节炎患者骨密度变化的临床研究

目的　探讨类风湿性关节炎 (RA)患者骨密度 (BMD)的变化和骨质疏松 (OP)的发生情况及其与临床指标的相关性。方法　采用双能X线骨密度仪 ,测量 5 3例RA患者和 63名正常人的前臂、腰椎和股骨区的BMD ,并同时测定各临床指标。结果　RA患者的骨量丢失较对照组明显(P <0 .0 5 ) ,除股骨颈外 ,各测定部位的BMD均明显低于对照组 (P <0 .0 5～ 0 .0 1)。RA患者中发生OP组较非OP组年龄更大 (P <0 .0 0 1) ,关节功能更差 (P <0 .0 0 1) ,健康评估表积分更高 (P <0 .0 1) ,握力更低 (P <0 .0 5 )。 2 8例服用糖皮质激素的RA患者中有 13例 ( 4 6.4% )发生OP ,明显高于未服用糖皮质激素组的 5 /2 5 ( 2 0 .0 % ) ( χ2 =4.113 ,P =0 .0 5 ) ,服用激素组腰椎 3 (L3 )的BMD明显低于未服用激素组 (t =2 .163 ,P =0 .0 5 )。LogisticRegression分析显示年龄 (OR =1.10 3 ,P =0 .0 1)和关节功能 (OR =5 .689,P =0 .0 1)为RA患者OP发生的相关因素。结论　RA患者多部位的BMD均显著降低。其BMD的降低和OP的发生是多因素的 ,与年龄、关节炎的严重程度和是否服用糖皮质激素等有关     

Sex steroids and bone density in premenopausal and perimenopausal women

Bone density begins to decline in women before menopause, and the degree of bone loss is variable. We performed a cross-sectional analysis on the entry data of a 5-yr prospective study of risk factors for osteoporosis to determine the correlation of bone density with serum sex steroid concentrations and body weight. We studied 292 healthy white women, aged 35-50 yr, who were menstruating regularly or had had menses in the past 12 months. Blood samples were drawn in the early follicular phase for estradiol (E2), testosterone (T), dehydroepiandrosterone sulfate, and sex hormone-binding globulin (SHBG). Free levels of E2 (FE2) and T (FT) were calculated based on total T and E2, SHBG, and albumin levels. Women were classified as premenopausal (FSH, less than 12 U/L) and perimenopausal (FSH greater than or equal to 12 U/L; n = 46; 16%). Bone density was measured by dual photon absorptiometry of the lumbar spine (L2-L4) and hip and by single photon absorptiometry of the wrist. Perimenopausal women were older than premenopausal women (45.5 +/- 3.5 and 41.0 +/- 3.9 yr, respectively), but did not differ in height or weight. While bone density did not correlate with age in each group, perimenopausal women had significantly lower bone density at the L2-L4 and femoral neck (L2-L4, 1.18 +/- 0.14 in perimenopausal and 1.24 +/- 0.12 g/cm2 in premenopausal women; femur, 0.84 +/- 0.11 in perimenopausal and 0.90 +/- 0.11 g/cm2 in premenopausal women; P less than 0.005). Body weight showed the strongest positive correlation with bone density. Log FT, percent FT, and FE2 percent correlated positively with bone density, even after controlling for weight. Log SHBG was negatively correlated with bone density in premenopausal women at the hip and wrist after controlling for weight. FSH was inversely correlated with bone density, and E2 and T were lower in perimenopausal than premenopausal women. These data suggest that women who are still menstruating may have relative deficiencies in both E2 and T, with reduced bone densities as a consequence.     

IgA rheumatoid factor is associated with bone mineral density preservation in rheumatoid arthritis

Clinical Rheumatology - Autoantibodies such as IgM rheumatoid factor (RF) and anti-citrullinated proteins/peptides antibodies (ACPA) have previously been incriminated in systemic bone loss in...     

Muscle strength characteristics and central bone mineral density in women with recent onset rheumatoid arthritis compared with healthy controls.

Muscle strength and bone mineral density (BMD) at the lumbar spine (BMDspine) and femoral neck (BMDfem) were determined in 20 healthy women and in 20 women with recent onset rheumatoid arthritis (RA). The mean duration of articular symptoms of the patients was eleven months and none of them had used glucocorticoids or disease modifying antirheumatic drugs. BMDs were measured by dual x-ray absorptiometry (DXA). Knee extension, trunk extension, and flexion as well as grip strength were measured with David 200 and Digitest dynamometers. BMDspine (1.17 g/cm2 and 1.20 g/cm2) and BMDfem (0.98 g/cm2 and 0.96 g/cm2) between the women with early RA and healthy women did not differ. However, knee extension strength was 46%, grip strength 31%, trunk extension strength 14% and overall muscle strength index 29% lower in RA women (p < 0.020-0.001) than in healthy subjects. Femoral neck BMD correlated statistically significantly with knee extension strength and muscle strength index in both groups and with trunk extension and flexion strength as well as rapid force development in RA women. The data indicates that the loss of muscle strength is clearly visible during the first months of disease but the significant bone loss at central bone regions develops later.     

Bone mineral density in women and men with early rheumatoid arthritis

OBJECTIVE: To study bone mineral density (BMD) in patients with early rheumatoid arthritis. METHODS: Dual x-ray absorptiometry was performed in 227 patients, 149 women and 78 men, with rheumatoid arthritis (RA) of no more than 12 months duration. RESULTS: Women, as well as men above 60 years of age, had a BMD at spine and hip comparable with age and sex matched reference populations. Men younger than 60 years had a tendency to lower BMD. Although the proportion of female patients with osteoporosis was not higher than in the reference, population the proportion of patients with reduced bone mass was increased, and this was found also in men. There was no significant association between BMD and disease duration, disease activity or disability. CONCLUSION: Untreated patients with early RA have a BMD in spine and hip not significantly different from that of normal reference populations. However, an increased number of the patients had reduced bone mass already at disease onset.