Abstract
BackgroundPatients with rheumatic diseases have a high risk for joint destruction and secondary osteoarthritis (OA) as well as low bone mineral density (BMD, i.e., osteoporosis). While several factors may lead to low BMD in these patients, the value of BMD measurements in rheumatic patients with end-stage OA scheduled for total joint arthroplasty is unknown.MethodsIn this retrospective cross-sectional study of 50 adults with secondary OA due to rheumatic diseases, we evaluated dual energy X-ray absorptiometry (DXA) measurements of both hips and the spine performed within 3 months prior to arthroplasty (n = 25 total hip arthroplasty, THA; n = 25 total knee arthroplasty, TKA). We analyzed various demographic and disease-specific characteristics and their effect on DXA results by using group comparisons and multivariate linear regression models.ResultsAlthough patients undergoing TKA were younger (63.2 ± 14.2 vs. 71.0 ± 10.8 yr., p = 0.035), osteoporosis was observed more frequently in patients scheduled for TKA than THA (32% vs. 12%). Osteopenia was detected in 13/25 patients (52%) in both the THA and TKA cohort. In the THA cohort, female sex, lower BMI and prednisolone use were associated with lower T-score in the hip. In TKA patients, higher OA grade determined by Kellgren-Lawrence score was associated with lower T-score in the hip of the affected side.ConclusionsOsteoporosis is present in a considerable frequency of rheumatic patients with end-stage OA, and THA and TKA patients show distinct frequencies and risk factors of low BMD. Our findings point to a potential value of DXA regarding preoperative evaluation of bone status.
Highlights
Patients with rheumatic diseases have a high risk for joint destruction and secondary osteoarthritis (OA) as well as low bone mineral density (BMD, i.e., osteoporosis)
Patients with rheumatoid arthritis (RA) and other rheumatic diseases have a high risk for joint destruction and secondary osteoarthritis (OA) as well as systemic bone loss reflected by low bone mineral density (BMD, i.e., osteoporosis) [1, 2]
A major part of both groups consisted of patients with RA (84% for both groups) with only few patients with psoriatic arthritis (PsA) or ankylosing spondylitis (AS)
Summary
Study cohort We retrospectively reviewed 50 consecutive patients with advanced joint destruction and/or end-stage secondary OA due to rheumatic diseases who underwent TJA in our clinic between 2018 and 2019. Patients with available DXA measurements within 3 months prior to surgery were included Both proximal femur and the lumbar spine (L1-L4) were evaluated by DXA. From these results, we determined the T- and Z-scores, which represent the standard deviation compared to 20 to 40-year-old, sex-matched healthy controls and age −/sex-matched controls, respectively. To determine possible predictors of BMD in the THA and TKA cohorts, we performed a multivariate regression model with age, sex, body mass index (BMI), Kellgren-Lawrence score and prednisolone dose as predictors of the T-score of the operated and non-operated side as well as the lumbar spine including all predictors at a single step. P-values of < 0.05 were considered as statistically significant
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