Bone mineral density changes in patients with rheumatoid arthritis


  • Ashna Swara Saleh Department of Rheumatology and Medical Rehabilitation, Rizgary Teaching Hospital, Erbil, Iraq.
  • Shwan K. Media Department of Internal Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq.



Rheumatoid arthritis, Bone loss, Bone densitometry


Background and objective: Bone loss regarded as a major health concern which is thought to be associated with a number of chronic illnesses including rheumatoid arthritis. This study was designed to determine the frequency of low bone mass as well as the influence of disease duration on bone mass in the patients with rheumatoid arthritis.

Methods: Sixty patients with rheumatoid arthritis who were visiting Rizgary Teaching Hospital in Erbil from April 2015 to March 2016were included in a cross-sectional study. Bone mineral density was measured using dual energy X-ray absorptiometry.

Results: There was increased frequency of bone loss in patients with rheumatoid arthritis. There was a positive association between bone mineral density of the spine and femoral neck with disease activity measured by disease activity score and disease activity index (P <0.05). There was a significant association between bone mineral density and disease duration. 

Conclusion: Significant proportions of patients with rheumatoid arthritis have osteoporosis at the femoral neck and lumber spine, and disease duration longer than five years is associated with a significant increase in bone loss.


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Doherty M, Lanyon P, Ralston SH. Rheumatoid arthritis. In: Boon NA; College NR; Walker BR; Hunter JAA (editors). Davidson’s principles and practice of medicine, 20th ed. New York: Churchill Livingstone; 2006. P.1101-6.

Taysi S, Polat F, Gul M, Sari RA, Bakan E. lipid peroxidation, some extracellar antioxidants and antioxidant enzymes in serum of patients with rheumatoid arthritis. RheumatolInt 2002;21:200-4.

Heimick CG, Flson DT, Lawrence RC .National Arthritis Data, work group (Jan.2008)."Estimate of the prevalence of arthritis and other rheumatic conditions in the US. part I . Arthritis Rheumatism 58(1):15-25.

Tehlirian CV, Bathon JM. Clinical and laboratory manifestations.IN: Klippel JH, Stone JH, White PH. Primer on the rheumatic diseases. New York: Springer Science & Business Media; 2008. P.114-21.

Aizer J, Reed G, Onofrie A, Harrisson MJ. Predictors of density testing in patients with rheumatoid arthritis. Rheumatol Int 2009; 29:897-905.

Richards JS, Peng J, Amdur RI. Dual energy x-ray absorptiometry and rheumatoid arthritis. J ClinDensitom 2009; 12:434-40.

Spector TD, Hall GM, McCloskey EV, Kanis JA. Risk of vertebral fracture in women with rheumatoid arthritis . BMJ 1993;306:558.

Huusko TM, KarppiP ,Avikainen H, Sulkava R. Threefold increase risk of hip fractures with rheumatoid arthritis incentralfinland. Ann Rheum Dis 2001; 60:521-2.

Van Leeuwen MA, van Rijswijk MH, van der Heijde DM, TeMeerman GJ, van Riel PL, Houtman PM, et al. The acute-phase response in relation to radiographic progression in early rheumatoid arthritis: a prospective study during the first three years of the disease. Br J Rheumatol 1993; 32(Suppl 3):9-13.

Tishler M, Caspi D, Yaron M. C – Reactive protein level in patients with rheumatoid arthritis, the impact of therapy. Clinical Rheumatol 1985;4(3):321-4.

Simpson DS. Methodological and reporting consideration. In: Fordham JN. Manual of bone densitometry measurement.London: Springer; 2000. P. 37-54.

Shenstone BD, Mahmoud A, Woodward R, ElvinsD,Palmer R, Ring EF, Bhalla AK. Longitudinal bone mineral density changes in early rheumatoid arthritis. Br J Rheumatol 1994; 33(6):541-5.

Kroger H, Honkanen R, Saarikoski S, Alhava E. Decreased axial bone mineral density in perimenopausal women with rheumatoid arthritis--a population based study. Ann Rheum Dis 1994; 53(1):18-23.

Haugeberg G, Orstavik RE, Uhlig T, Falch JA, Halse JI, Kvien TK. Bone loss in patients with rheumatoid arthritis: results from a population-based cohort of 366 patients followed up for two years. Arthritis Rheum 2002;46(7):1720-8.

Mula K. A study of the bone density of rheumatoid arthritis patients in Khozestan province]. Journal of Shahid Sadoghi University of medical sciences and health services 2002; 3: 8-12.

Hui-Hong Piao, Ke-Qin Zhang, Zi-Hui Tang. Association between rheumatoid arthritics and osteoporosis among Chinese men, a community based study. Int J ClinExp Med 2015;8(9):16592-8.

Lee SG, Park YE, Park SH, Kim TK, Choi HJ, Lee SJ, et al. Increased frequency of osteoporosis and BMD below the expected range for age among South Korean women with rheumatoid arthritis. Int J Rheum Dis 2012; 15: 289-96.

Haugeberg G, Uhlig T, Falch JA, Halse JI, Kvien TK. Bone mineral density and frequency of os­teoporosis in female patients with rheumatoid arthritis: results from 394 patients in the Oslo County Rheumatoid Arthritis register. Arthritis Rheum 2000; 43: 522-30.

Moon SJ, Ahn IE, Kwok SK, Park KS, Min JK, Park SH, et al. Periarticular osteopo­rosis is a prominent feature in early rheuma­toid arthritis: estimation using shaft to periar­ticular bone mineral density ratio. J Korean Med Sci 2013; 28: 287-94.

Deal C. Bone loss in rheumatoid arthritis: sys­temic, periarticular, and focal. CurrRheumatol Rep 2012; 14: 231-7.

Lane NE, Pressman AR, Star VL, Cummings SR, Nevitt MC. Rheumatoid arthritis and bone mineral density in elderly women. The Study of Osteoporotic Fractures Research Group. J Bone Miner Res 1995; 10(2):257- 63.

Dunne CA, Moran CJ, Thompson PW. The effect of regular intramuscular corticosteroid therapy on bone mineral density in rheumatoid patients. Scand J Rheumatol 1995; 24(1):48-9.

Buckley LM, Leib ES, Cartularo KS, Vacek PM, Cooper SM. Effects of low dose corticosteroids on the bone mineral density of patients with rheumatoid arthritis. J Rheumatol 1995; 22(6):1055-9.

Devlin J, Lilley J, Gough A, Huissoon A, Holder R, Reece R, et al. Clinical associations of dual-energy X-ray absorptiometry measurement of hand bone mass in rheumatoid arthritis. Br J Rheumatol 1996; 35(12):1256-62.

Cortet B, Flipo RM, Blanckaert F, Duquesnoy B, Marchandise X, Delcambre B. Evaluation of bone mineral density in patients with rheumatoid arthritis. Influence of disease activity and glucocorticoid therapy. Rev RhumEngl Ed 1997; 64(7-9):451-8.

Hansen M, Florescu A, Stoltenberg M, Podenphant J, Pedersen-Zbinden B, Horslev-Petersen K, et al. Bone loss in rheumatoid arthritis. Influence of disease activity, duration of the disease, functional capacity, and corticosteroid treatment. Scand J Rheumatol 1996; 25(6):367-76.

Hafez EA, Mansour HE, Hamza SH, Moftah SG, Younes TB, Ismail MA. Bone Mineral Density Changes in Patients with Recent-Onset Rheumatoid Arthritis. Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders 2011:4 87–94.

Heidari B, Jalali F. Bone densitometry in patients with Rheumatoid Arthritis. ActaMedicaIranica 2005; 43: 2.

Lodder M C, Jong Z, Kostense P J, Molenaar ETH, Staal K , Voskuyl A E, et al. Relation between disease severity and low bone mineral density. Ann Rheum Dis 2004; 63:1576-80 doi:10.1136/ard.2003.016253

Genant H K, Cooper C, Poor G, Reid I, Ehrlich G, Kanis J, et al. Interim report and recommendations of the World Health Organization Task Force for Osteoporosis. Osteoporos Int1999; 10:259–64




How to Cite

Saleh, A. S., & Media, S. K. (2017). Bone mineral density changes in patients with rheumatoid arthritis. Zanco Journal of Medical Sciences (Zanco J Med Sci), 21(2), 1757–1764.



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