Skip to main content
SpringerLink
Log in

Osteopenia in rheumatoid arthritis: a biochemical, hormonal and histomorphometric study

  • Originals
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Summary

To determine whether the osteopenia of rheumatoid arthritis (RA) is due to reduction of trabecular bone mass (TBV) and/or cortical width (CW), we evaluated these parameters by bone histomorphometry; we also measured the calciotropic hormones parathormone(PTH) and calcitonin (CT), vitamin D [25(OH)D] and the biological markers of bone remodeling in a group of patients with RA. Study subjects were divided into Group C — premenopausal patients, and Group A — menopausal patients and men of the same ages. These groups were compared to two agematched control groups, B and D. In both A vs. B and C vs. D, TBV and CW were significantly lower in patients. There were no differences in PTH or CT, but 25(OH)D was significantly reduced, and BGP, OHP/Cr and AP were raised in patients. Patients also exhibited TBV loss in more than 55% and CW loss in more than 98%. These changes suggest that the decline in bone mass, mainly cortical, but also trabecular, is due to increased bone turnover and enhanced resorption and seem to reflect intrinsic alterations of RA.

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

Similar content being viewed by others

References

  1. Baarwell, R. Disease of the Joints. London, Hardwicke, 1865.

    Google Scholar 

  2. Saville, P., Karmosh, D. Osteoporosis of rheumatoid arthritis: influence of age, sex and corticosteroid. Arthritis Rheum 1967, 10, 423–430.

    Article  PubMed  CAS  Google Scholar 

  3. Duncan, H., Frost, H.M., Villanueva, A.R., Singer, J.W. The osteoporosis of rheumatoid arthritis. Arthritis Rheum 1965, 8, 943–954.

    Article  PubMed  CAS  Google Scholar 

  4. Kennedy, A.C., Lindsay, R. Bone involvement in rheumatoid arthritis. Clin Rheum Dis 1977, 3, 403–420.

    Google Scholar 

  5. Espinoza, L.R. Rheumatoid arthritis: etiopathogenetic considerations. Clin Lab Med 1986, 6, 27–40.

    PubMed  CAS  Google Scholar 

  6. Duncan, H. Osteoporosis in rheumatoid arthritis and corticosteroid-induced osteoporosis. Orthop Clin Norh Am 1972, 3, 571–583.

    CAS  Google Scholar 

  7. Rico, H., Del Rio, A., Ciguenza, G., Diaz, J., Espinos, D. Prevalencia de la osteoporosis en la artritis reumatoide y factores de influencia. Rev Esp Reumatol 1978, 5, 37–46.

    Google Scholar 

  8. Zanzi, I., Roginski, M.S., Ellis, K.J., Blau, S., Chon, S.H. Skeletal mass in rheumatoid arthritis: a comparison with forearm bone mineral content. Am J Rheumatol 1976, 126, 1305–1306.

    CAS  Google Scholar 

  9. Kennedy, A.C., Body, K., Willians, E.D. Whole body elemental composition during drug treatment of rheumatoid arthritis: a preliminary study. Ann Rheum Dis 1979, 38, 137–140.

    Article  PubMed  CAS  Google Scholar 

  10. Meunier, P.J., Coupron, P. Iliac trabecular bone volume in 236 controls. Representativeness of iliac crest. Ed: Jaworski, Z.F.G, In: Proc Firts Workshop Bone Morphometry. Ottawa, University Ottawa Press, 1973, 100–105.

    Google Scholar 

  11. Meisen, F., Mosekilde, L. The role of bone biopsy in the diagnosis of metabolic bone disease. Orthop Clin North Am 1981, 12, 571–602.

    PubMed  Google Scholar 

  12. Talmage, R.V. A study of the effect of parathyroid hormone on bone remodelling and calcium homeostasis. Clin Orthop 1967, 54, 163–173.

    PubMed  CAS  Google Scholar 

  13. Nordin, B.E.C. Metabolic Bone Disease. London, Churchill-Livingstone, 1973.

    Google Scholar 

  14. Hernandez, E.R., Rico, H., Diaz-Mediavilla, J., Diaz-Rubio, E., Sanz, J. Volumen trabecular oseo en una muestra de poblacion espanola. An Med Intern 1987, 4, 375–378.

    Google Scholar 

  15. Prockop, D.J., Sjoerdsma, A. Significance of hydroxyproline in man. J Clin Invest 1961, 40, 843–849.

    Article  PubMed  CAS  Google Scholar 

  16. Tausky, H.H. A microcolorimetric determination of creatinine in urine by Jaffe reaction. J Biol Chem 1954, 208, 853–856.

    PubMed  Google Scholar 

  17. Haddad, J.G., Chyu, K.G. Competitive proteinbinding radio assay for 25-hydroxycholesterol. J Clin Endocrinol Metab 1971, 33, 992–995.

    Article  PubMed  CAS  Google Scholar 

  18. Byers, P., Smith, R. Trephine for full thickness iliac crest biopsy. Lancet 1967, 1, 682–683.

    Google Scholar 

  19. Villanueva, A.R. A bone stain for osteoid seams in fresh unembebbed, mineralized bone. Stain Technol 1974, 49, 1–8.

    PubMed  CAS  Google Scholar 

  20. Rosenspire, K.C., Kennedy, A.C., Steinbach, J. Investigation of the metabolic activity of bone in rheumatoid arthritis. J Rheumatol 1980, 7, 469–473.

    PubMed  CAS  Google Scholar 

  21. Rajapakse, C., Thompson, R., Grennan, O.M. Increased bone metabolism in the rheumatoid arthritis as measurement by the whole-body retention of 99-TCM-methylene diphosphonate. Ann Rheum Dis 1983, 42, 138–141.

    Article  PubMed  CAS  Google Scholar 

  22. Als, O.S., Gotfredsenn, A., Christiansen, C. The effect of glucocorticoids on bone mass in rheumatoid arthritis patients. Arthritis Rheum 1985, 28, 369–375.

    Article  PubMed  CAS  Google Scholar 

  23. Sambrook, P.N., Eisman, J.A., Champion, G.D., Yates, M.G., Pocock, N.A., Esbri, S. Determinants of axial bone loss in rheumatoid arthritis. Arthritis Rheum 1987, 30, 721–728.

    Article  PubMed  CAS  Google Scholar 

  24. Steen-Hansen, E., Hove, B., Andresen, J. Bone mass in patients with rheumatoid arthritis. Skeletal Radiol 1987, 16, 556–559.

    Article  PubMed  CAS  Google Scholar 

  25. Dequeker, J. Quantitative radiology: radiogrametry of cortical bone. Br J Radiol 1976, 22, 3–8.

    Google Scholar 

  26. Julkunen, H. Medical aspects in the treatment of femoral neck fracture with rheumatoid arthritis. Scand J Rheumatol 1974, 3, 13.

    Article  PubMed  CAS  Google Scholar 

  27. Stromquist, B. Hip fracture in rheumatoid arthritis. Acta Orthop Scand 1984, 55, 624–628.

    Article  PubMed  Google Scholar 

  28. Bird, H.A., Wright, V., Hennes, U., Theiss, E. Comparison of serum 1,25-dihydroxycholecalciferol concentrations in rheumatoid arthritis and osteoarthritis. Ann Rheum Dis 1982, 41, 257–258.

    Article  PubMed  CAS  Google Scholar 

  29. Sambrook, P.N., Abeyasekera, G., Ansell, B.M., Foster, S., Gumpell, J.M., Hill, P.A., Reeve, J., Stevenson, J.C. Calcium absorption in rheumatoid arthritis. Ann Rheum Dis 1985, 44, 585–588.

    Article  PubMed  CAS  Google Scholar 

  30. Als, O.S., Riis, B., Christiansen, C. Serum concentration of vitamin D metabolites in rheumatoid arthritis. Clin Rheumatol 1987, 6, 238–243.

    Article  PubMed  CAS  Google Scholar 

  31. Maddison, P.S., Bacon, P.B. Vitamin D deficiency, spontaneous fractures and osteopenia in rheumatoid arthritis. Br Med J 1974, 2, 433–435.

    Article  Google Scholar 

  32. Kokof, F., Kuska, J., Bialas, B. Parathormone, calcitonin, 25-hydroxycalciferol and bone histology in patients with rheumatoid arthritis. Aktuel Rheumatol 1983, 8, 118–122.

    Article  Google Scholar 

  33. Lips, P., Van Soesbergen, R., Bloot, A., Netelenbos, J.C. Bone histomorphometry in rheumatoid arthritis. Bone 1985, 6, 415.

    Article  Google Scholar 

  34. Kennedy, A.C., Allam, B.F., Rooney, P.J. Hypercalcemia in rheumatoid arthritis: investigation of its causes and implications. Ann Rheum Dis 1979, 38, 401–412.

    Article  PubMed  CAS  Google Scholar 

  35. Crips, A.J., Helliwell, M., Grahame, R. The effect of hyperparathyroidism on the course of rheumatoid arthritis. Br J Rheumatol 1983, 22, 22–28.

    Article  PubMed  Google Scholar 

  36. Andress, D.L., Endres, D.B., Maloney, N.A., Kopp, J.B., Coburn, J.W., Sherrad, D.J. Comparison of parathyroid hormone assay with bone histomorphometry in renal osteodystrophy. J Clin Endocrinol Metab 1987, 64, 1163–1169.

    Google Scholar 

  37. Ng, K.C., Revell, P.A., Beer, M., Boucher, B.J., Cohen, R.D., Currey, H.L.F. Incidence of metabolic bone disease in rheumatoid arthritis and osteoarthritis. Ann Rheum Dis 1984, 43, 37–377.

    Article  Google Scholar 

  38. Baker, M.R., Peacock, M., Nordin, B.E.C. The decline vitamin D status with age. Age Ageing 1980, 9, 249–252.

    Article  PubMed  CAS  Google Scholar 

  39. Haussler, M.R., Drenzer, M.K., Pikc, J.W., Chandler, J.S., Hagan, L.A. Assay of 1,25 dihydroxyvitamin D and other active metabolites in serum: applications to animals and humans. Eds: Norman, A.V. et al. In: Vitamin D, Basic Research and Its Clinical Application. Berlin, DeGruyter, 1979, 189–196.

    Google Scholar 

  40. Sambrook, P.N., Ansell, B.M., Gumpel, J.A., Hesp, R., Reeve, J., Zanelli, J.M. Bone turnover in early rheumatoid arthritis. Bone 1985, 6, 280.

    Article  Google Scholar 

  41. Rico, H., Cabranes, J.A., Hernandez, E.R., Gomez-Castresana, F. Diferencias en la osteocalcina en pacientes con artritis reumatoide de presentacion tempranna o tardia no sometidos a tratamiento. An Med Intern 1987, 4, 113–115.

    Google Scholar 

  42. Weisman, M.H., Orth, R.W., Catherwood, B.D., Manolagas, S.C., Feftos, L.J. Measures of bone loss in rheumatoid arthritis. Arch Intern Med 1986, 146, 701–704.

    Article  PubMed  CAS  Google Scholar 

  43. Couch, M., Woods, D.A., Gallagher, J.A., Preston, C.J., Coulton, L.A., Russell, R.G.G.G., Kanis, J.A., Dickson, I.R., Poser, J.W. Considerations when measuring serum osteocalcin. Bone 1985, 6, 59.

    Article  Google Scholar 

  44. Gevers, G., Devos, P., DeRoo, M., Dequeker, J. Increased levels of osteocalcin (Bone Gla Protein) in rheumatoid arthritis (RA). Bone 1985, 6, 482.

    Article  Google Scholar 

  45. Shimizu, U., Shiozawa, S., Shiozawa, K. Quantitative histologic studies on the pathogenesis of periarticular osteoporosis in rheumatoid arthritis. Arthritis Rheum 1985, 28, 25–31.

    Article  PubMed  CAS  Google Scholar 

  46. Als, O.S., Gotfredsen, A., Riis, B.J., Christiansen, C. Are disease duration and degree of functional impairement determinants of bone loss in rheumatoid arthritis? Ann Rheum Dis 1985, 44, 406–411.

    Article  PubMed  CAS  Google Scholar 

  47. Lian, J.L., Gundberg, C.M. Osteocalcin. Clin Orthop 1988, 226, 267–291.

    PubMed  CAS  Google Scholar 

  48. Ekestam, E.A., Ljunghall, S., Hallgren, R. Serum osteocalcin in rheumatoid arthritis and other inflammatory arthritis, relation between inflammatory activity and the effect of glucocorticoids and remission-inducing drugs. Ann Rheum Dis 1986, 45, 484–490.

    Article  PubMed  Google Scholar 

  49. Kendall, M.J., Cockel, R., Becker, J., Hawkins, C.F. Raised serum alkaline phosphatase in rheumatoid disease. Arthritis Rheum Dis 1970, 29, 537–540.

    Article  CAS  Google Scholar 

  50. Rau, R., Kuhn, H.A. Die leber bei der progredientchronischen Polyarthritis. Schweiz Med Wochenschr 1972, 102, 635–640.

    PubMed  CAS  Google Scholar 

  51. Wordworth, B.P., Vipond, S., Woods, C.G., Mowat, A.G. Metabolic bone disease among in-patients with rheumatoid arthritis. Br J Rheumatol 1984, 23, 251–257.

    Article  PubMed  Google Scholar 

  52. Pettersson, T., Wegelius, O. Biopsy diagnosis of amyloidosis in rheumatoid arthritis. Gastroenterology 1972, 62, 22–27.

    PubMed  CAS  Google Scholar 

  53. Eastgate, J.A., Symons, J.A., Wood, N.C., Grinlinton, F.M., DiGiovine, F.S., Duff, G.W. Correlation of plasma interleukin 1 levels with disease activity in rheumatoid arthritis. Lancet 1988, 2, 706–709.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Medical School, Universidad de Alcalá de Henares, Madrid, Spain

    H. Rico, E. R. Hernandez, F. Gomez-Castresana, M. Yague, J. A. Cabranes & R. Valor

  2. Surgery Department, Universidad de Alcalá de Henares, Madrid, Spain

    F. Gomez-Castresana

  3. Nuclear Medicine Department, Madrid, Spain

    J. A. Cabranes

  4. Central Laboratory of the Hospital Universitario San Carlos, Madrid, Spain

    R. Valor

Authors
  1. H. Rico
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. R. Hernandez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F. Gomez-Castresana
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Yague
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. A. Cabranes
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R. Valor
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rico, H., Hernandez, E.R., Gomez-Castresana, F. et al. Osteopenia in rheumatoid arthritis: a biochemical, hormonal and histomorphometric study. Clin Rheumatol 9, 63–68 (1990). https://doi.org/10.1007/BF02030244

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02030244

Key words

Search

Navigation