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Incidence of vertebral deformities in 255 female rheumatoid arthritis patients measured by morphometric X-ray absorptiometry

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Abstract

To date, no studies have been published on incident deformities in patients with rheumatoid arthritis (RA). Morphometric X-ray absorptiometry (MXA) is an alternative to conventional X-rays for identifying vertebral deformities. The aim of the present study was to describe the incidence of vertebral deformities in 255 female RA patients measured by MXA, and the relationship between incident deformities and clinical and demographic variables. MXA is still under evaluation for its ability to identify deformities, so we explored four different cut-off thresholds including fixed percentage reduction and the principle of least significant change (LSC). MXA (T4–L4) and BMD (L2–L4 and total hip; Lunar Expert) were performed on 255 patients (mean age 54.3, range 29.2–70.8 years) at baseline and after a mean period of 2.3 years. MXA scans were analyzed pairwise by the same trained technician, and incident deformities calculated applying LSC with a 99.9% and 99.99% confidence limit, and a fixed reduction of 20% and 25% for anterior, middle or posterior heights. Long term precision (%CV) of height measurements for all vertebrae combined (T4–L4) were 4.8, 4.8 and 4.4, respectively. Frequency and distribution of incident deformities varied from 39 deformities in 33 patients (fixed 20% reduction) to 17 deformities in 15 patients (fixed 25% reduction), and quality control analyses revealed a high number of presumed false deformities. Incidence per 100 patient years varied from 2.9 to 6.7 deformities according to method, and was comparable to those obtained from intervention studies in corticosteroid-induced osteoporosis. Patients with incident deformities were significantly older, had lower BMD, higher disability and more often a previous non-vertebral fractures than those without incident deformities Incident deformities by MXA need further evaluation in secondary osteoporosis. It seems, however, that older patients with previous limb fractures and low BMD are especially prone to this complication.

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Acknowledgements

We gratefully appreciate the expert technical assistance of our research nurses Margareth Sveinsson, Ingerid Müller, Sidsel Arnkvaern and Anne Katrine Kongtorp, and then medical student Espen Haavardsholm for performing the MXA analyses. This study was supported in part by grants from The Research Council of Norway, Lions Clubs International MD 104 Norway, The Norwegian Rheumatism Association, The Norwegian Women Public Health Association and The Norwegian Osteoporosis Foundation. None of the sponsors took any part in the design of the study, analysis of results or writing of the article.

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Authors and Affiliations

  1. Department of Rheumatology, Diakonhjemmet Hospital, Box 23, Vinderen, 0319, Oslo, Norway

    Ragnhild E. Ørstavik, Glenn Haugeberg, Till Uhlig, Petter Mowinckel & Tore K. Kvien

  2. Department of Internal Medicine, Aker Hospital, Oslo, Norway

    Jan A. Falch

  3. Clinic of Osteoporosis, Oslo, Norway

    Johan I. Halse

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  1. Ragnhild E. Ørstavik
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  2. Glenn Haugeberg
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  3. Till Uhlig
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  4. Petter Mowinckel
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  5. Jan A. Falch
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  6. Johan I. Halse
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  7. Tore K. Kvien
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Correspondence to Ragnhild E. Ørstavik.

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Ørstavik, R.E., Haugeberg, G., Uhlig, T. et al. Incidence of vertebral deformities in 255 female rheumatoid arthritis patients measured by morphometric X-ray absorptiometry. Osteoporos Int 16, 35–42 (2005). https://doi.org/10.1007/s00198-004-1631-4

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  • DOI: https://doi.org/10.1007/s00198-004-1631-4

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