Relationship of Focal Erosions, Bone Mineral Density, and Parathyroid Hormone in Rheumatoid Arthritis

Objective. To investigate the relationship among focal bone erosions and bone mineral density (BMD), 25(OH) vitamin D (25OHD), and parathyroid hormone (PTH) values in patients with rheumatoid arthritis (RA). Methods. The study included 1191 RA patients (1014 women, 177 men, mean age 58.9 +/- 11.1 yrs) participating in a multicenter, cross-sectional study. Results. Radiographic evidence of typical bony erosions on hands or forefeet was found in 64.1% of patients. In those with bone erosions as compared to those without, mean BMD Z score values were significantly lower at both the spine (-0.74 +/- 1.19 vs 0.46 +/- 1.31; p = 0.05) and the hip (-0.72 +/- 1.07 vs -0.15 +/- 1.23; p <0.001). In the subgroup of patients not taking vitamin D supplements, PTH levels were significantly higher in those with erosive arthritis (25.9 +/- 14.0 vs 23.1 +/- 11.6 pg/ml; p = 0.01); whereas the 25OHD concentrations were very similar in the 2 groups. The mean differences for BMD and PTH among the erosive and nonerosive RA remained statistically significant when values were simultaneously adjusted for all disease and mineral metabolism factors (i.e., age, sex, menopause, disease duration, Disease Activity Score 28-joint count, Health Assessment Questionnaire, activities of daily living, Steinbrocker functional state, glucocorticoid therapy, body weight, and bisphosphonate treatment). Conclusion. Our results suggest that the presence of bone erosions in RA correlates with low BMD levels and high PTH levels, and that these associations are independent of the degree of functional impairment and other common determinants of bone mass and mineral metabolism in adults with RA. These findings suggest that treatments to prevent bone loss or suppress PTH levels might positively affect the progression of bone erosions in RA. (First Release April 1 2011; J Rheumatol 2011;38:997-1002; doi:10.3899/jrheum.100829)