Vitamin D, Inflammatory Markers, Steroid Use and Systemic Factors: which Is the Culprit in Rheumatoid Arthritis Associated Osteoporosis?

Abstract

Aim. To explore the risk factors for osteoporosis in Rheumatoid Arthritis (RA) patients. Methods. A cross-sectional study was conducted on 93 patients meeting the American College of Rheumatology – European League Against Rheumatism classification criteria for RA 2010(ACR-EULAR). Serum 25-OH vitamin D (25(OH) D levels was measured. In addition, the levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), rheumatoid factor (RhF), anticyclic - citrullinated protein/peptide antibodies (Anti-CCP) were assessed. Dual-energy X-ray absorptiometry (DEXA) was also used to measure the bone mineral density BMD of the left femur at the time of recruitment.  Results. The RA cohort was predominantly female (88.2%). The average age of the participants was 46.5±15.2 years. Osteoporosis was present in 25 (26.9%). Osteoporotic cases were significantly older (p <0.001), female (p = 0.032) and had significantly more frequencies of diabetes (p = 0.022) and   hypertension (p = 0.018) and had significantly lower calcium (p = 0.038). Logistic regression model for factors affecting osteoporosis showed that Steroids intake, increasing age and decreasing serum calcium were factors increasing the likelihood of having osteoporosis. Vitamin D did not show any relation with osteoporosis.  Serum inflammatory markers like ESR, CRP, R.F and anti- CCP were higher in osteoporotic group but not significant. Conclusions. The results of this analysis indicated that systemic factors like age and intake of steroids are culprit factors in rheumatoid arthritis associated osteoporosis.