Risk factors for vertebral fracture in menopausal or postmenopausal Japanese women with rheumatoid arthritis: a cross-sectional and longitudinal study
Risk factors for vertebral fracture in menopausal or postmenopausal Japanese women with rheumatoid arthritis: a cross-sectional and longitudinal study
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DOI：
10.1007/s00774-005-0657-9
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发表时间：
2006-03-01
影响因子：
3.3
通讯作者：
Endo, N
中科院分区：
文献类型：
--
作者：
Arai, K;Hanyu, T;Endo, N
对117例绝经和绝经后的日本类风湿性关节炎（RA）女性患者（年龄50 ~ 64岁）进行了4年的横断面和纵向椎骨骨折发生率的研究。排除接受双膦酸盐治疗的患者。在4年的开始和结束时，通过侧位胸椎和腰椎X线片诊断椎体骨折。双能X线骨密度仪（DXA）测定L2-L4骨密度（BMD），并记录皮质类固醇或甲氨蝶呤的使用情况和I型胶原N端肽（NTx）的尿排泄量。在横断面研究中，类风湿关节炎患者初次X线片中椎骨骨折的患病率为21%，而年龄匹配的健康对照组中为5%。在接受皮质类固醇治疗的RA患者中，33%的患者发生椎体骨折，其患病率显著高于未接受类固醇治疗的RA患者。在纵向研究中，60岁以上患者的椎骨骨折患病率也增加。接受类固醇治疗且BMD/YAM（年轻成人平均值）比值低于70%的RA患者发生椎骨骨折的风险高于BMD/YAM比值为70%-80%的患者，而BMD/YAM比值为80%或更高的患者发生椎骨骨折的风险高于BMD为80%或更高的患者。低剂量甲氨蝶呤对椎骨骨折无不良影响。如前所述，RA患者尿NTx较高，4年后有或无新发骨折的患者之间无差异。总之，60岁以上接受皮质类固醇治疗或BMD低于80%的日本RA患者发生椎体骨折的风险较高。
The occurrence of vertebral fracture was examined cross-sectionally and longitudinally over a 4-year interval in 117 menopausal and postmenopausal Japanese women with rheumatoid arthritis (RA), whose ages ranged from 50 to 64 years. Patients treated with bisphosphonate were excluded. Vertebral fracture was diagnosed by lateral thoracic and lumbar spine radiography at the start and end of a 4-year period. Bone mineral density (BMD) at L2-L4 according to dual-energy X-ray absorptiometry (DXA), the administration of corticosteroids or methotrexate, and urinary excretion of N-telopeptide of type I collagen (NTx) were also recorded. In the cross-sectional study, the prevalence of vertebral fracture in the initial radiographs of RA patients was 21%, while it was 5% in healthy age-matched controls. Among RA patients treated with corticosteroids, 33% had vertebral fracture, which was a significantly higher prevalence than that in RA patients without steroid administration. In the longitudinal study, vertebral fracture prevalence was also increased in patients more than 60 years old. RA patients having steroid treatment and a BMD/YAM (young adult mean) ratio below 70% had higher risk of vertebral fracture than patients with a BMD/YAM ratio of 70%-80%, which in turn exceeded the risk with a BMD of 80% or more. No adverse effect of low-dose methotrexate on vertebral fracture was found. Urinary NTx was high in RA patients, as reported previously, and did not differ between patients with or without new fracture after 4 years. In conclusion, Japanese RA patients more than 60 years old who were treated with corticosteroid or had a BMD below 80% had high risk of vertebral fracture.