Association between osteoporosis and rheumatoid arthritis in women
a cross-sectional study
Keywords:
Rheumatoid arthritis, Osteoporosis, Diet, Body composition, Physical activity, Parathyroid hormoneAbstract
CONTEXT AND OBJECTIVES: Osteoporosis has frequently been observed in patients with rheumatoid arthritis. The present study was undertaken in order to evaluate factors associated with osteoporosis among women with rheumatoid arthritis. DESIGN AND SETTING: Cross-sectional study, carried out in a public hospital in São Paulo. METHODS: The participants were 83 women with rheumatoid arthritis (53.7 ± 10.0 years old). Bone mineral density (BMD) and body composition were measured by dual energy X-ray absorptiometry. The patients were divided into three groups according to BMD: group 1, normal BMD (n = 24); group 2, osteopenia (n = 38); and group 3, osteoporosis (n = 21). Tests were performed to compare differences in means and correlations, with adjustments for age, duration of disease and cumulative corticosteroid. The relationships between clinical factors, physical activity score, dietary intake, body composition and biochemical parameters were analyzed using linear regression models. RESULTS: Mean calcium, vitamin D and omega-6 intakes were lower than the recommendations. Associations were found between BMD and age, disease duration, parathyroid hormone concentration and fat intake. The linear regression model showed that being older, with more years of disease and lower weight were negatively correlated with BMD [Total femur = 0.552 + 0.06 (weight) + 0.019 (total physical activity) – 0.05 (age) – 0.003 (disease duration); R2 = 48.1; P < 0.001]. CONCLUSION: The present study indicates that nutritional factors and body composition are associated with bone mass in women with rheumatoid arthritis.
Downloads
References
Brandão L, Ferraz MB, Zerbini CAF. Avaliação da qualidade de vida na artrite reumatóide: revisão atualizada [Evaluation of quality of life in rheumatoid arthritis]. Rev Bras Reumatol. 1997;37(5):275-81.
Pattison DJ, Harrison RA, Symmons DP. The role of diet in susceptibility to rheumatoid arthri- tis: a systematic review. J Rheumatol. 2004;31(7):1310-9.
Gabriel SE. The epidemiology of rheumatoid arthritis. Rheum Dis Clin North Am. 2001;27(2):269-81.
Martin JC, Munro R, Campbell MK, Reid DM. Effects of disease and corticosteroids on appendicular bone mass in postmenopausal women with rheumatoid arthritis: comparison with axial measurements. Br J Rheumatol. 1999;36(1):43-9.
Lodder MC, Haugeberg G, Lems WF, et al. Radiographic damage associated with low bone mineral density and vertebral deformities in rheumatoid arthritis: the Oslo-Truro-Amsterdam (OSTRA) collaborative study. Arthritis Rheum. 2003;49(2):209-15.
Bezerra MC, Carvalho JF, Prokopowitsch AS, Pereira RM. RANK, RANKL and osteoprotegerin in arthritic bone loss. Braz J Med Biol Res. 2005;38(2):161-70.
van Staa TP. The pathogenesis, epidemiology and management of glucocorticoid-induced osteoporosis. Calcif Tissue Int. 2006;79(3):129-37.
Stone J, Doube A, Dudson D, Wallace J. Inadequate calcium, folic acid, vitamin E, zinc, and selenium intake in rheumatoid arthritis patients: results of a dietary survey. Semin Arthritis Rheum. 1997;27(3):180-5.
Roubenoff R, Roubenoff RA, Cannon JG, et al. Rheumatoid cachexia: cytokine-driven hyper- metabolism accompanying reduced body cell mass in chronic inflammation. J Clin Invest. 1994;93(6):2379-86.
Beck TJ, Oreskovic TL, Stone KL, et al. Structural adaptation to changing skeletal load in progression toward hip fragility: the study of osteoporotic fractures. J Bone Miner Res. 2001;16(6):1108-19.
Reid IR, Plank LD, Evans MC. Fat mass is an important determinant of whole body bone den- sity in premenopausal women but not in men. J Clin Endocrinol Metab. 1992;75(3):779-82.
Lina JB, Stein GS, Canalis E, Robey PG, Boskey AL. Bone formation: osteoblast lineage cells, growth factors, matrix proteins, and the mineralization process. In: Favus MJ, editor. Primer on the metabolic bone disease and disorders of mineral metabolism. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 1999. p. 14-29.
Heaney RP. Protein and calcium: antagonists or synergists? Am J Clin Nutr. 2002;75(4): 609-10.
Basu S, Michaëlsson K, Olofsson H, Johansson S, Melhus H. Association between oxidative stress and bone mineral density. Biochem Biophys Res Commun. 2001;288(1):275-9.
Mody N, Parhami F, Sarafian TA, Demer LL. Oxidative stress modulates osteoblastic differen- tiation of vascular and bone cells. Free Radic Biol Med. 2001;31(4):509-19.
Martínez-Ramírez MJ, Palma S, Martínez-González MA, Delgado-Martínez AD, de la Fuente C, Delgado-Rodríguez M. Dietary fat intake and the risk of osteoporotic fractures in the elderly. Eur J Clin Nutr. 2007;61(9):1114-20.
Kruger MC, Horrobin DF. Calcium metabolism, osteoporosis and essential fatty acids: a review. Prog Lipid Res. 1997;36(2-3):131-51.
Claassen N, Coetzer H, Steinmann CM, Kruger MC. The effect of different n-6/n-3 essential fatty acid rations on calcium balance and bone in rats. Prostaglandins Leukot Essent Fatty Acids. 1995;53(1):13-9.
Das UN. Essential fatty acids and osteoporosis. Nutrition. 2000;16(5):386-90.
Priante G, Bordin L, Musacchio E, Clari G, Baggio B. Fatty acids and cytokine mRNA ex- pression in human osteoblastic cells: a specific effect of arachidonic acid. Clin Sci (Lond). 2002;102(4):403-9.
Meydani SN, Endres S, Woods MM, et al. Oral (n-3) fatty acid supplementation suppresses cytokine production and lymphocyte proliferation: comparison between young and older women. J Nutr. 1991;121(4):547-55.
Weiss LA, Barrett-Connor E, von Mühlen D. Ratio of n-6 to n-3 fatty acids and bone mineral density in older adults: the Rancho Bernardo Study. Am J Clin Nutr. 2005;81(4):934-8.
Simopoulos AP. The importance of the ratio of omega-6/omega-3 essential fatty acids. Bio- med Pharmacother. 2002;56(8):365-79.
Simopoulos AP. The importance of the omega-6/omega-3 fatty acid ratio in cardiovascular disease and other chronic diseases. Exp Biol Med (Maywood). 2008;233(6):674-88.
Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988;31(3):315-24.
Assessment of fracture risk and its application to screening for postmenopausal osteoporo- sis. Report of a WHO Study Group. World Health Organ Tech Rep Ser. 1994;843:1-129.
Levin J. Estatística aplicada a ciências humanas. 2a ed. São Paulo: Harbra Ltda; 1987.
Fries JF, Spitz P, Kraines RG, Holman HR. Measurement of patient outcome in arthritis. Arthri- tis Rheum. 1980;23(2):137-45.
Prevoo ML, van’t Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL. Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum. 1995;38(1):44-8.
Pereira GA, Genaro PS, Santos LC, et al. Validation of a food frequency questionnaire for women with osteoporosis. J Nutr Health Aging. 2009;13(5):403-7.
Willett W, Stampfer M. Implications of total energy intake for epidemiological analyses. In: Willett W, editor. Nutrition epidemiology 2nd ed. New York: Oxford University Press; 1998. p. 273-301.
Food and Nutrition Board. Institute of Medicine. Dietary reference intakes for energy, car- bohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids (macronutrients). Washington: National Academy Press; 2005. Available from: http://www.nap.edu/catalog. php?record_id=10490#orgs. Accessed in 2009 (Aug 10).
Institute of Medicine. Dietary reference intakes for calcium, phosphorus, magnesium, vi- tamin D and fluoride. Washington: National Academy Press; 1997. Available from: http:// www.nap.edu/catalog.php?record_id=5776. Accessed in 2009 (Aug 10).
Baeck JA, Burema J, Frijters JE. A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Am J Clin Nutr. 1982;36(5):936-42.
Baumgartner RN, Stauber PM, Koehler KM, Romero L, Garry PJ. Associations of fat and muscle masses with bone mineral in elderly men and women. Am J Clin Nutr. 1996;63(3):365-72.
Munro R, Capell H. Prevalence of low body mass in rheumatoid arthritis: association with the acute phase response. Ann Rheum Dis. 1997;56(5):326-9.
Summers GD, Deighton CM, Rennie MJ, Booth AH. Rheumatoid cachexia: a clinical perspec- tive. Rheumatology (Oxford). 2008;47(8):1124-31.
Lanyon L, Skerry T. Postmenopausal osteoporosis as a failure of bone’s adaptation to func- tional loading: a hypothesis. J Bone Miner Res. 2001;16(11):1937-47.
Chung CP, Russell AS, Segami MI, Ugarte CA. The effect of low-dose prednisone on bone mi- neral density in Peruvian rheumatoid arthritis patients. Rheumatol Int. 2005;25(2):114-7.
Dykman TR, Gluck OS, Murphy WA, Hahn TJ, Hahn BH. Evaluation of factors associated with glucocorticoid-induced osteopenia in patients with rheumatic diseases. Arthritis Rheum. 1985;28(4):361-8.
Saraiva GL, Cendoroglo MS, Ramos LR, et al. Prevalência da deficiência, insuficiência de vitamina D e hiperparatiroidismo secundário em idosos institucionalizados e moradores na comunidade da cidade de São Paulo, Brasil [Prevalence of vitamin D deficiency, insuffi- ciency and secondary hyperparathyroidism in the elderly inpatients and living in the com- munity of the city of São Paulo, Brazil]. Arq Bras Endocrinol Metabol. 2007;51(3):437-42.
Simopoulos AP. Omega-3 fatty acids in health and disease and in growth and development. Am J Clin Nutr. 1991;54(3):438-63.
Simopoulos AP. Essential fatty acids in health and chronic disease. Am J Clin Nutr. 1999;70(3 Suppl):560S-569S.
Calder PC. n-3 polyunsaturated fatty acids, inflammation, and inflammatory diseases. Am J Clin Nutr. 2006;83(6 Suppl):1505S-1519S.
Sambrook PN, Spector TD, Seeman E, et al. Osteoporosis in rheumatic arthritis. A monozygo- tic co-twin control study. Arthritis Rheum. 1995;38(6):806-9.
Oelzner P, Müller A, Deschner F, et al. Relationship between disease activity and serum levels of vitamin D metabolites and PTH in rheumatoid arthritis. Calcif Tissue Int. 1998;62(3):193-8.
Saag KG, Shane E, Boonen S, et al. Teriparatide or alendronate in glucocorticoid-induced osteoporosis. N Engl J Med. 2007;357(20):2028-39.
Masi L, Simonini G, Piscitelli E, et al. Osteoprotegerin (OPG)/RANK-L system in juvenile idiopathic arthritis: is there a potential modulating role for OPG/RANK-L in bone injury? J Rheumatol. 2004;31(5):986-91.
Romas E, Gillespie MT. Inflammation-induced bone loss: can it be prevented? Rheum Dis Clin North Am. 2006,32(4):759-73.
