Biologic therapies and bone loss in rheumatoid arthritis. 3D analysis by dual-energy X-ray absorptiometry (DXA).

BRANCE ML ; PONS-ESTEL BA; QUAGLIATO NJ; JORFEN M; BERBOTTO G; CORTESE N; RAGGIO JC; SOLDANO J; PALATNIK M; CHAVERO I; DIEGUEZ C; SÁNCHEZ A; DEL RIO L; DI GREGORIO S; BRUN LR

Quito

Congreso; 2019 PANLAR Meeting; 2019

PANLAR

Introduction: Rheumatoidarthritis (RA) is an autoimmune disease characterized by chronic inflammatorysymmetric progressive polyarthritis with bone affectation. While severalstudies show favorable bone effect of biological drugs, there are noconclusions about fractures prevention. The 3D analysis of the proximal femurby dual-energy X-ray absorptiometry (DXA) allowsthe evaluation of cortical and trabecular bone separately and has shown a verygood correlation with computed tomography. Aim: Evaluate changes in corticaland trabecular bone in patients with RA treated with different therapeuticschemes. Patients and methods: Adults female andmale RA patients (n=105), 30 under biologic therapies (RA+Biol) and 75 treatedwith non-biological DMARDs (RA+No-Biol) were included. As control group (CG),100 subjects matched by age, sex and body mass index (BMI) were included. BMD(g/cm2) was measured DXA (Hologic Discovery Wi) on bilateral femoralneck (FN) and total hip (TH). The 3D analysis was performed with3D-Shaper software (v2.9, Galgo Medical, Spain). The following parameter wereconsider: integral volumetric BMD (integral vBMD -mg/cm3), cortical BMD (sDens -mg/cm2) and trabecular volumetric BMD(trabecular vBMD - mg/cm3).The distribution of the data was evaluated with the Shapiro-Wilk test andparametric or non-parametric tests were used as appropriate. Data wereexpressed as mean±SD and p<0.05 was considered significant. Results: Nodifferences in age (CG: 52.1±12.6 y, RA: 53.3±13.4 y), sex (CG: 84 female and16 male, RA: 87 female and 18 male), BMI (CG: 26.0±5.1, RR: 27.8±4.6) andpercentage of pre and postmenopausal women, were found between groups. FN andTH BMD were significantly lower in RA patients (p<0.0001 in each evaluatedregion) mainly due to RA+No-Biol group. TH BMD was significantly lower inRA+No-Biol vs CG (right TH BMD= CG: 0.935±0.117; RA+No-Biol: 0.852±0.133, -8.9%,p<0.0001; left TH BMD= CG: 0.801±0.117; RA+No-Biol: 0.728±0.118, -9,1%, p=0.0002).Consistent with TH, right and left FN BMD were lower in RA+No-Biol comparedwith CG. The RA-Biol only showed significant lower values in left FN comparedwith CG. The 3D analysis of both femurs indicated that the AR+No-Biol hasaffected both trabecular and cortical bone (right trabecular vBMD= CG:195.9±38.9, RA+No-Biol: 176.6±46.3,-9,8%, p=0.0097; right sDens= CG: 164.5±20.3,RA+No-Biol: 150.2±23.7, 8.7%, p=0.0001; right integralvBMD= CG: 339.0±51.8, RA+No-Biol: 307.5±63.6,-9.3%, p=0.0016). The AR+Biol group showed nosignificant difference compared to CG Control in all of the analyzedparameters. Conclusion: 1. The areal BMD by DXA and the volumetric BMD werehigher in patients under biological treatment. 2. The 3D analysis showedcortical and trabecular bone separately and could be a useful tool tofound early trabecular changes, a site mainlyaffected in RA patients. An additional analysis according to the activityand disease duration and cumulative glucocorticoids dose is required.