Distinct biomarkers for different bones in osteoporosis with rheumatoid arthritis

Arthritis Res Ther. 2019 Jul 15;21(1):174. doi: 10.1186/s13075-019-1956-1.


Background: Rheumatoid arthritis (RA) is known to cause secondary osteoporosis and fragility fractures. This study aimed to identify biomarkers predictive of bone mineral density (BMD) change at three anatomical sites in patients with RA.

Methods: We conducted a prospective longitudinal study in patients with RA. In 2012, we recruited 379 patients from an RA cohort, 329 of whom underwent evaluation of blood and urine biomarkers together with measurement of BMD in the lumbar spine, proximal femur, and distal forearm. The BMD in these three regions was reassessed in 2014. We performed multivariate linear regression analysis to identify those factors associated with BMD change.

Results: The averages of age, body mass index, and disease activity score in 28 joints (DAS28) at baseline were 63.2 (minimum to maximum, 32-85), 21.3 (12.3-30.0), and 3.2 (0.1-5.9), respectively. Univariate analysis showed that the annual BMD change was significantly associated with the use of steroid, bisphosphonate (BP) or vitamin D (VitD), and serum homocysteine in the lumber spine; DAS28, the use of BP or VitD, CRP, and anti-cyclic citrullinated peptide antibody (ACPA) in the proximal femur; and the dosage of MTX, the use of BP or VitD, and serum tartrate-resistant acid phosphatase 5b (TRACP-5b) in the distal forearm, respectively.

Conclusions: Predictive biomarkers for BMD change in RA patients differ at each anatomical site. Practitioners should treat each anatomical site with different markers and prescribe osteoporosis drugs to prevent fractures for RA patients.

Keywords: Bone metabolism marker; Bone mineral density; Cohort study; Osteoporosis; Rheumatoid arthritis.

MeSH terms

  • Absorptiometry, Photon / methods
  • Adult
  • Aged
  • Aged, 80 and over
  • Arthritis, Rheumatoid / diagnosis
  • Arthritis, Rheumatoid / drug therapy
  • Arthritis, Rheumatoid / metabolism*
  • Biomarkers / analysis*
  • Biomarkers / blood
  • Biomarkers / urine
  • Bone Density / drug effects
  • Bone Density Conservation Agents / therapeutic use
  • Bone and Bones / drug effects
  • Bone and Bones / metabolism*
  • Diphosphonates / therapeutic use
  • Female
  • Femur / drug effects
  • Femur / metabolism
  • Humans
  • Longitudinal Studies
  • Lumbar Vertebrae / drug effects
  • Lumbar Vertebrae / metabolism
  • Male
  • Middle Aged
  • Osteoporosis / diagnosis
  • Osteoporosis / drug therapy
  • Osteoporosis / metabolism*
  • Prospective Studies
  • Radius / drug effects
  • Radius / metabolism
  • Ulna / drug effects
  • Ulna / metabolism
  • Vitamin D / therapeutic use


  • Biomarkers
  • Bone Density Conservation Agents
  • Diphosphonates
  • Vitamin D