cross sectional study on bone mineral density in rheumatoid arthritis

Osteoporosis in women with rheumatoid arthritis [RA] is a subject of great interest. This study aims at the determination of the frequency of osteoporosis in RA patients and investigates the main clinical determinants of bone mineral density [BMD] in this disease. Subjects and The work included sixty female patients with RA fulfilling the American Rheumatism Association criteria [ARA], irrespective of their age or menopausal state. BMD was measured in patients at the wrist and lumbar spine. The results showed a significantly higher body mass index [BMI] in patients with normal BMD. Rheumatoid patients with osteoporosis had a longer disease duration than the other groups [P=0.012]. All postmenopausal patients and 67% of premenopausal patients had a low BMD. All patients with normal BMD were pre-menopausal. Health assessment questionnaire [HAQ] was higher in patients with low BMD and osteoporotic patients [P=0.031 and 0.018]. The same is detected for Ritchie articular index [P=0.024,0.022 and 0.036 for low BMD, osteopenia and osteoporosis, respectively] The visual analogue questionnaire [VAQ] was significantly higher in low BMD, osteopenia and osteoporosis compared to the normal BMD group [P=0.000 for all]. Serum calcium was significantly lower, while alkaline phosphatase and rheumatoid factor were higher in low BMD, osteopenia and osteoporosis patients than normal BMD. It is concluded that osteoporosis is a feature of rheumatoid arthritis; it is increased with BMI, longer disease duration, post-menopausal women and increase disease activity

Osteoporotic changes in Egyptian cirrhotic patients

Aim: Hepatic osteodystrophy occurs in most patients with chronic liver disease. Subjects and In this study, bone density, measured by dual energy X-ray absorptiometry [DEXA], and some biochemical markers of bone turnover were studied in 30 Egyptian schistosomal patients classified equally into 3 groups according to the Child-Pugh score of severity of liver disease. Patients showed significant reduction of BMD in both lumbar spine and femoral neck [LS: -2.87 +/- 1.39; FN: -0.54 +/- 1.13, p< 0.001]. Osteoporosis was found in 56.7% of patients. Urinary D-Pyr/cr, as a marker of bone resorption, showed marked significant increase in Child B and C patients [p<0.001], while serum B-AP and serum PICP, as markers of bone formation, showed less changes. Serum B-AP was significantly increased in the patient group [p<0.05], while serum PICP was insignificantly decreased in patients as compared to controls. The rate of bone loss, determined by the ratio of urinary D-Pyr/cr to PICP, was increased in Child A, B, and C patients. Serum testosterone was significantly decreased in both Child B and C patients and was markedly decreased in the whole patient group [p<0.001]. Conclusions: These results suggest that increased bone resorption is the predominant cause of hepatic osteodystrophy and its risk increases with the severity of liver disease. It also provides bone biomarkers as useful alternatives to bone biopsy in evaluating hepatic bone changes