Skip to main content
SpringerLink
Log in

Measurement of periarticular bone mineral density in the hands of patients with early inflammatory arthritis using dual energy x-ray absorptiometry

  • Brief Report
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Hand bone densitometry is more sensitive than standard radiology in the measurement of disease-related bone damage in early arthritis. Most studies employing dual energy x-ray absorptiometry (DXA) have evaluated the whole hand. The aim of this study was to evaluate a method that quantified bone density in regions of interest that were confined to the juxta-articular areas of metacarpo-phalangeal (MCP) and proximal interphalangeal (PIP) joints. Patients with inflammatory arthritis affecting the hands were selected for study. Postero-anterior (PA) scans of selected juxta-articular sub-regions were acquired using a Hologic 4500 Elite bone densitometer and forearm software. Each hand was scanned three times in immediate succession with repositioning between scans. The six selected sub-regions included the periarticular regions of the second, third, and fourth MCP and PIP joints. Sub-regions of different dimensions (4 and 5 mm proximal and distal to the joint space) were assessed at each joint. Coefficients of variation (CV) were calculated for bone mineral density (BMD) and bone mineral content (BMC) of each selected sub-region. Eighty four individual hand joints in seven patients were evaluated three times. Precision values ranged between 0.89% and 2.37% for BMD and between 1.38 and 3.26 for BMC measurements. BMD measurements of MCP joints were more precise than PIP joints. BMD measurements of 10-mm sub-regions were more precise than 8-mm sub-regions. The precision value for the net average BMD measurement of the six sub-regions evaluated was 0.78% for 8-mm sub-regions and 0.73% for 10-mm sub-regions. Net average BMC measurements had CV values of 1.11% and 1.08%, respectively. DXA can be used to reliably measure periarticular BMD and BMC of small joints in the hands in patients with early inflammatory arthritis. Precision values for quantifying juxta-articular bone approximated BMD measurements of the spine.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Arnett FC, Edworthy SM, Bloch DA et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324

    Article  PubMed  CAS  Google Scholar 

  2. Devlin J, Lilley J, Gough A et al (1996) Clinical associations of dual-energy X-ray absorptiometry measurement of hand bone mass in rheumatoid arthritis. Br J Rheumatol 35:1256–1262

    Article  PubMed  CAS  Google Scholar 

  3. Peel NF, Spittlehouse AJ, Bax DE, Eastell R (1994) Bone mineral density of the hand in rheumatoid arthritis. Arthritis Rheum 37:983–991

    Article  PubMed  CAS  Google Scholar 

  4. Deodhar AA, Brabyn J, Jones PW, Davis MJ, Woolf AD (1995) Longitudinal study of hand bone densitometry in rheumatoid arthritis. Arthritis Rheum 38:1204–1210

    Article  PubMed  CAS  Google Scholar 

  5. Fries JF, Bloch DA, Sharp JT et al (1986) Assessment of radiologic progression in rheumatoid arthritis. A randomized, controlled trial. Arthritis Rheum 29:1–9

    Article  PubMed  CAS  Google Scholar 

  6. Catto GR, McIntosh JA, Macleod M (1973) Partial body neutron activation analysis in vivo: a new approach to the investigation of metabolic bone disease. Phys Med Biol 18:508–517

    Article  PubMed  CAS  Google Scholar 

  7. Maziere B, Kuntz D, Comar D, Ryckewaert A (1979) In vivo analysis of bone calcium by local neutron activation of the hand: results in normal and osteoporotic subjects. J Nucl Med 20:85–91

    PubMed  CAS  Google Scholar 

  8. Nicoll JJ, Smith MA, Reid D et al (1987) Measurement of hand bone mineral content using single-photon absorptiometry. Phys Med Biol 32:697–706

    Article  PubMed  CAS  Google Scholar 

  9. Pye DW, Law A (1990) The measurement of total hand bone mineral content by QDR. In: Ring EFJ (ed) Current research in osteoporosis and bone mineral measurement. London Institute of Radiology, London

    Google Scholar 

  10. Deodhar AA, Brabyn J, Jones PW, Davis MJ, Woolf AD (1994) Measurement of hand bone mineral content by dual energy x-ray absorptiometry: development of the method, and its application in normal volunteers and in patients with rheumatoid arthritis. Ann Rheum Dis 53:685–690

    Article  PubMed  CAS  Google Scholar 

  11. Deodhar AA, Brabyn J, Pande I, Stanley E, Woolf AD (1998) A five years longitudinal study of hand bone densitometry in early rheumatoid arthritis. Arthritis Rheum 41(S52):115

    Google Scholar 

  12. Harrison BJ, Hutchinson CE, Adams J, Bruce IN, Herrick AL (2002) Assessing periarticular bone mineral density in patients with early psoriatic arthritis or rheumatoid arthritis. Ann Rheum Dis 61:1007–1011

    Article  PubMed  CAS  Google Scholar 

  13. Madsen OR, Suetta C, Egsmose C, Lorentzen JS, Sorensen OH (2004) Bone status in rheumatoid arthritis assessed at peripheral sites by three different quantitative ultrasound techniques. Clin Rheumatol 23:324–329

    Article  PubMed  CAS  Google Scholar 

  14. Stewart A, McKenzie LM, Black AJ, Reid DM (2004) Predicting erosive disease in rheumatoid arthritis. A longitudinal study of changes in bone density using digital X-ray radiogrammetry; a pilot study. Rheumatology 43:1561–1564

    Article  PubMed  CAS  Google Scholar 

  15. Haugeberg G, Emery P (2005) Value of dual-energy x-ray absorptiometry as a diagnostic and assessment tool in early rheumatoid arthritis. Rheum Dis Clin North Am 31:715–728

    Article  PubMed  Google Scholar 

  16. Daragon A, Krzanowska K, Vittecoq O, Menard JF, Hau I, Jouen-Beades F, Lesage C, Bertho JM, Tron F, Le Loet X (2001) Prospective x-ray densitometry and ultrasonography study of the hand bones of patients with rheumatoid arthritis of recent onset. Joint Bone Spine 68:34–42

    Article  PubMed  CAS  Google Scholar 

  17. Jensen T, Klarlund M, Hansen M, Jensen KE, Podenphant J, Hansen TM, Skjodt H, Hyldstrup L, the TIRA group (2004) Bone loss in unclassified polyarthritis and early rheumatoid arthritis is better detected by digital x ray radiogrammetry than dual x ray absorptiometry: relationship with disease activity and radiographic outcome. Ann Rheum Dis 63:15–22

    Article  PubMed  CAS  Google Scholar 

  18. Jensen T, Hansen M, Jensen KE, Podenphant J, Hansen TM, Hyldstrup L (2005) Comparison of dual X-ray absorptiometry (DXA), digital X-ray radiogrammetry (DXR), and conventional radiographs in the evaluation of osteoporosis and bone erosions in patients with rheumatoid arthritis. Scand J Rheumatol 34:27–33

    Article  PubMed  CAS  Google Scholar 

  19. Casteneda S, Gonzalez-Alvaro I, Rodriguez-Salvanes R, Quintana ML, Laffon A, Garcia-Vadillo JA (2007) Reproducibility of metacarpophalangeal bone mass measurements obtained by dual-energy x-ray absorptiometry in healthy volunteers and patients with early arthritis. J Clin Densitometry 10:298–305

    Article  Google Scholar 

  20. Jawaid WB, Crosbie D, Shotton J, Reid DM, Stewart A (2006) Use of digital x-ray radiogrammetry in the assessment of joint damage in rheumatoid arthritis. Ann Rheum Dis 65:459–464

    Article  PubMed  CAS  Google Scholar 

  21. Berglin E, Lorentzon R, Nordmark L, Nillson-Sojka B, Randtapaa Dahlqvist S (2003) Predictors of radiological progression and changes in hand bone density in early rheumatoid arthritis. Rheumatology 42:268–275

    Article  PubMed  CAS  Google Scholar 

  22. Haugeberg G, Lodder MC, Lems WF, Uhlig T, Orsatavik RE, Dijkmans BAC, Kvein TK, Woolf AD (2004) Hand cortical bone mass and its association with radiographic joint damageand fractures in 50–70 year old female patients with rheumatoid arthritis: cross sectional Oslo–Truro–Amsterdam (OSTRA) collaborative study. Ann Rheum Dis 63:1331–1334

    Article  PubMed  CAS  Google Scholar 

  23. Haugeberg G, Green MJ, Quinn MA, Marzo-Ortego H, Proudman S, Karim Z, Wakefield RJ, Conaghan PG, Stewart S, Emery P (2006) Hand bone loss in early undifferentiated arthritis: evaluating bone mineral density loss before the development of rheumatoid arthritis. Ann Rheum Dis 65:736–740

    Article  PubMed  CAS  Google Scholar 

  24. Deodhar AA, Brabyn J, Pande I, Scott DL, Woolf AD (2003) Hand bone densitometry in rheumatoid arthritis, a five year longitudinal study: an outcome measure and a prognostic marker. Ann Rheum Dis 62:767–770

    Article  PubMed  CAS  Google Scholar 

  25. Haugeberg G, Green MJ, Conaghan PG, Quinn M, Wakefield R, Proudman SM, Stewart S, Hensor E, Emery P (2007) Hand bone densitometry: a more sensitive standard for the assessment of early bone damage in rheumatoid arthritis. Ann Rheum Dis 66:1513–1517

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Rheumatology, St. Vincent’s University Hospital, Elm Park, Dublin, 4, Ireland

    Eithne Murphy, Barry Bresnihan & Oliver FitzGerald

Authors
  1. Eithne Murphy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Barry Bresnihan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Oliver FitzGerald
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Barry Bresnihan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Murphy, E., Bresnihan, B. & FitzGerald, O. Measurement of periarticular bone mineral density in the hands of patients with early inflammatory arthritis using dual energy x-ray absorptiometry. Clin Rheumatol 27, 763–766 (2008). https://doi.org/10.1007/s10067-007-0833-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-007-0833-5

Keywords

Search

Navigation