Predicting value of forearm bone density on osteoporosis in patients with postmenopausal rheumatoid arthritis and its influencing factors / 中国医师进修杂志

ABSTRACT

Objective To explore the predictive value of forearm bone density on osteoporosis in patients with postmenopausal rheumatoid arthritis (RA) and its influencing factors.Methods The clinical data of 98 postmenopausal RA patients in Department of Endocrinology and Hematology,the Third People's Hospital of Hangzhou from January 1,2016 to December 31,2018 were retrospectively analyzed.The bone density of the forearm (left) and central axis (lumbar spine and left hip) were measured using dual-energy X-ray absorptiometry (DXA),and the score of health assessment questionnaires (HAQ) was evaluated.The relationship between central axis bone density and forearm bone density,the optimal T value of forearm bone density for the diagnosis of lumbar spine and left hip osteoporosis,and the influencing factors of forearm bone density were analyzed.Results In 98 patients with postmenopausal RA,lumbar vertebrae bone density was (0.92 ± 0.17) g/cm2,and T value was -0.7 ± 0.4;left hip bone density was (0.80 ± 0.15) g/cm2,and T value was-1.2 ± 1.1;forearm bone density was (0.36 ± 0.13) g/cm2,bone mineral content was (0.72 ± 0.23) g/cm,and T value was -2.3 ± 1.8.The central axial bone density measurement result showed that normal bone density was in 15 cases (15.31％),and abnormal bone density was in 83 cases (84.69％).The lumbar spine bone density measurement result showed that normal bone density was in 36 cases (36.73％),and abnormal bone density was in 62 cases (63.27％).The left hip bone density measurement result showed that normal bone density was in 19 cases (19.39％),and abnormal bone density was in 79 cases (80.61％).The forearm bone density measurement result showed that normal bone density was in 24 cases (24.49％),and abnormal bone density was in 74 cases (75.51％).The age was significantly younger,the forearm bone density,bone mineral content and T value were significantly higher in patients with normal central axial bone,lumbar spine and left hip bone density,compared with those in patients with abnormal central axial bone,lumbar spine and left hip bone density respectively,and there were statistical differences (P ＜ 0.01 or ＜ 0.05);there was no statistical difference in body mass index (P ＞ 0.05).The receiver operating characteristic curve analysis result showed that the area under curve (AUC) of forearm bone density for the diagnosis of lumbar osteoporosis was 0.842 (95％ CI 0.795 to 0.913),and the optimal T value was -2.46,with a sensitivity of 75.00％,and a specificity of 85.48％;the AUC of forearm bone density for diagnosis of left hip osteoporosis was 0.849 (95％ CI 0.802 to 0.908),and the optimal T value was-2.32,with a sensitivity of 73.68％,and a specificity of 83.54％.The age,duration of disease and HAQ score in patients with normal forearm bone density were significantly lower than those in patients with abnormal forearm bone density(50.21 ± 11.92) years vs.(58.45 ± 14.13) years,(6.95 ± 2.41) years vs.(9.73 ± 3.17) years and (1.14 ± 0.36) scores vs.(1.63 ± 0.51) scores,and there were statistical differences (P＜ 0.05 or ＜ 0.01);there was no statistical difference in body mass index (P＞ 0.05).Multivariate Logistic regression analysis result showed that age,duration of disease and HAQ score were independent risk factors for forearm bone density in patients with postmenopausal RA (OR =1.829,2.347 and 3.732;95％ CI 1.123 to 2.980,1.244 to 4.428 and 1.160 to 12.003;P ＜ 0.05 or ＜ 0.01).Conclusions Forearm bone density can be used as an auxiliary tool for screening central axial osteoporosis in patients with postmenopausal RA.