Abstract
Bone mass, bone geometry and its changes are based on trabecular and cortical bone remodeling. Whereas the effects of estrogen loss, rheumatoid arthritis (RA), glucocorticoid (GC) and bisphosphonate (BP) on trabecular bone remodeling have been well described, the effects of these conditions on the cortical bone geometry are less known. The present review will report current knowledge on the effects of RA, GC and BP on cortical bone geometry and its clinical relevance. Estrogen deficiency, RA and systemic GC lead to enhanced endosteal bone resorption. While in estrogen deficiency and under GC therapy endosteal resorption is insufficiently compensated by periosteal apposition, RA is associated with some periosteal bone apposition resulting in a maintained load-bearing capacity and stiffness. In contrast, BP treatment leads to filling of endosteal bone cavities at the epiphysis; however, periosteal apposition at the bone shaft seems to be suppressed. In summary, estrogen loss, RA and GC show similar effects on endosteal bone remodeling with an increase in bone resorption, whereas their effect on periosteal bone remodeling may differ. Despite over 50 years of GC therapy and over 25 years of PB therapy, there is still need for better understanding of the skeletal effects of these drugs as well as of inflammatory disease such as RA on cortical bone remodeling.
Highlights
Rheumatoid arthritis (RA) is a chronic inflammatory joint disease characterized by destruction of periarticular bone and cartilage and soft-tissue damage, leading toIn the last years, several case studies have linked RA with increased risk of bone shaft fractures at the metatarsal, tibial and femoral bones [5,6,7]
In a recent report of summarized clinical data on cases with shaft fractures associated with BP, the task force of the American Society for Bone Mineral Research [6] found that patients with atypical fractures of the femur had a higher number of comorbid conditions such as RA and underwent therapy with GC [8]
With a newly established protocol using peripheral quantitative computed tomography (QCT) we investigated the differences in volumetric bone mineral density (BMD) and bone geometry at the metacarpal bone, tibia and radius in 50 female RA patients and compared it with 100 healthy female controls [3]
Summary
Rheumatoid arthritis (RA) is a chronic inflammatory joint disease characterized by destruction of periarticular bone and cartilage and soft-tissue damage, leading toIn the last years, several case studies have linked RA with increased risk of bone shaft fractures at the metatarsal, tibial and femoral bones [5,6,7]. In a recent report of summarized clinical data on cases with shaft fractures associated with BP, the task force of the American Society for Bone Mineral Research [6] found that patients with atypical fractures of the femur had a higher number of comorbid conditions such as RA (odds ratio = 16.5) and underwent therapy with GC (odds ratio = 5.2) [8]. If periosteal apposition is impaired, endosteal resorption will produce cortical thinning and loss of bone mass and strength, predisposing to fractures.
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