Quantitative ultrasound and bone mineral density: discriminatory ability in patients with rheumatoid arthritis and controls with and without vertebral deformities

• Published in: Annals of the rheumatic diseases Vol. 63; no. 8; pp. 945 - 951
• Main Authors: Ørstavik, R E, Haugeberg, G, Uhlig, T, Mowinckel, P, Kvien, T K, Falch, J A, Halse, J I
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and European League Against Rheumatism 01.08.2004; BMJ; BMJ Publishing Group LTD
• Subjects: Absorptiometry, Photon; ACR; Aged; American College of Rheumatology; Anthropometry; Arthritis, Rheumatoid - complications; Arthritis, Rheumatoid - diagnostic imaging; Arthritis, Rheumatoid - drug therapy; Biological and medical sciences; BMD; Bone Density; bone mineral density; broadband ultrasound attenuation; BUA; DAS; disease activity score; Diseases of the osteoarticular system; dual energy x ray absorptiometry; DXA; Extended Report; Female; Fractures; Glucocorticoids - adverse effects; Humans; Inflammatory joint diseases; Medical sciences; Middle Aged; ORAR; Oslo rheumatoid arthritis register; Osteoporosis; quantitative ultrasound; QUS; Rheumatism; Rheumatoid arthritis; SOS; speed of sound; Spinal Fractures - diagnostic imaging; Spinal Fractures - etiology; Spinal Fractures - physiopathology; stiffness index; Studies; Ultrasonography; vertebral deformities; Ability; Human; Immunopathology; Deformation; Diseases of the osteoarticular system; Rheumatology; Autoimmune disease; Vertebra; Inflammatory joint disease; Chronic; Rheumatoid arthritis; Bone mineral density; Ultrasound; Quantitative analysis
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/ard.2003.010819

Background: Quantitative ultrasound (QUS) is a reliable tool for discriminating between subjects with and without vertebral deformities in postmenopausal osteoporosis. Less is known about osteoporosis caused by inflammatory diseases or corticosteroid use. Objectives: (1) To compare in patients with rheumatoid arthritis the ability of QUS and dual energy x ray absorptiometry (DXA) to discriminate between those with and without vertebral deformities; (2) to explore whether the results are similar in population based controls. Methods: Standardised lateral radiographs of the spine were obtained from 210 patients with rheumatoid arthritis aged over 50 years and 210 individually matched controls. Vertebral deformities were assessed morphometrically and semiquantitatively. All participants underwent bone measurements by DXA (Lunar Expert) and QUS (Lunar Achilles+). Receiver operating curve (ROC) analysis was used to compare the discriminating ability of BMD and QUS measurements in patients and controls with and without vertebral deformities. Analyses were repeated in patients stratified according to corticosteroid use. Results: For all bone measurements except lumbar spine in the rheumatoid arthritis group, BMD discriminated significantly between the patients with and without vertebral deformities, and the results were similar to those obtained in controls. Among current corticosteroid users, neither QUS nor DXA could discriminate between subjects with and without vertebral deformities. Conclusions: These findings support QUS as an alternative tool for identifying patients at risk of having vertebral deformities in rheumatoid arthritis, although results should be interpreted with caution in current users of corticosteroids.