Frequency of Osteoporosis, Risk Factors Linked to Lower BMD Identified in Patients With Psoriatic Arthritis

More than half of patients with psoriatic arthritis (PsA) have osteopenia or osteoporosis, with an increased risk for femoral osteoporosis in patients with axial involvement, hypertension, ischemic heart disease, and vitamin D deficiency, according to study results presented at the American College of Rheumatology (ACR) Convergence 2021, held virtually from November 3 to 10, 2021.

The current study was aimed at investigating the frequency of osteoporosis and identifying potential risk factors associated with lower bone mineral density (BMD) in the lumbar spine and femoral neck among patients with PsA.

The cross-sectional study included 155 patients with PsA screened using dual-energy x-ray absorptiometry. Femoral neck osteopenia was observed in 74 patients (47.7%) and lumbar spine osteopenia was reported in 51 patients (33.5%). Rates of osteoporosis were 7.2% in the lumbar spine and 7.1% in the femoral neck.

Although osteoporosis in general and femoral neck were associated with age, there was no association with the time of evolution of PsA. There was no association between lumbar spine osteoporosis and age or average evolution time of PsA.

While lumbar spine osteopenia was more common among women than men (42.1% vs 25%, respectively; odds ratio [OR], 1.515, 95% CI, 1.020-2.249; P =.026), femoral neck osteopenia was more common among men than women (11.4% vs 2.6%, respectively; OR, 4.75, 95% CI, 0.99-22.8; P =.057).

A history of inflammatory bowel disease was associated with an 8-fold higher risk for lumbar spine osteopenia (OR, 8.511; 95% CI, 0.926-78.247; P =.044).

Several risk factors were associated with increased risk for femoral neck osteoporosis, including axial involvement (OR, 3.882; 95% CI, 1.115-13.518; P =.024), hypertension (OR, 9.9; 95% CI, 2.055-47.689; P <.001), ischemic heart disease (OR, 7.657, 95% CI, 1.914-30.630; P <.001), and vitamin D deficiency (<20 ng/dL; OR, 8.727; 95% CI, 0.921-82.691; P =.046).

Researchers did not observe an association between the presence of osteoporosis and current or previous treatments. However, treatment with disease-modifying antirheumatic drugs (DMARDs) was associated with a lower risk for osteopenia (OR, 3.28; 95% CI, 0.98-10.96; P =.04).

Multivariate analysis showed that ischemic heart disease was associated with a 2-fold higher risk for osteoporosis (OR, 2.08; P =.42) and a 3-fold higher risk for femoral osteoporosis (OR, 3.17; P =.002). Hyperuricemia was associated with a reduced risk for osteoporosis (P =.002). Osteopenia was associated with age (OR, 2.64; P =.01); no significant associations were shown with axial involvement and time of disease evolution.

“In our cohort, [osteoporosis] is more frequent in men, it is associated with age despite the time of evolution of the disease. Femoral [osteoporosis] is more frequent in patients with axial involvement, hypertension, heart ischemic disease and vitamin D deficiency,” the researchers concluded.

Reference

Rojas Herrera SM, Abascal IB, Fernanddez-Martos MP, et al. Osteoporosis in psoriatic arthritis. Presented at: ACR Convergence 2021; November 3-10, 2021. Abstract 1325.