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Influence of systemic bone mineral density on atlantoaxial subluxation in patients with rheumatoid arthritis

Title
Influence of systemic bone mineral density on atlantoaxial subluxation in patients with rheumatoid arthritis
Author
한명훈
Keywords
Atlantoaxial subluxation; Atlantodental interval; Cervical spine instability; Rheumatoid arthritis
Issue Date
2017-03
Publisher
SPRINGER LONDON LTD
Citation
OSTEOPOROSIS INTERNATIONAL, v. 28, no. 6, page. 1931-1938
Abstract
Osteopenia and osteoporosis were independent predictive factors for higher atlantoaxial subluxation occurrence in patients with lower body mass index. Our findings suggest that patients with rheumatoid arthritis with osteopenia or osteoporosis, particularly those with lower body mass index (BMI), should be screened regularly to determine the status of their cervical spines. Cervical spine involvement in rheumatoid arthritis (RA) patients may cause serious adverse effects on quality of life and overall health. This study aimed to evaluate the association between atlantodental interval (ADI), atlantoaxial subluxation (AAS), and systemic bone mineral density (BMD) based on BMI variations among established patients with RA. The ADI was transformed to the natural log scale to normalize distributions for all analyses. Multivariable linear regression analyses were used to identify independent predictive factors for ADI based on each BMD classification. Multivariate Cox regression analyses were also performed to identify independent predictive factors for the risk of AAS, which were classified by tertile groups of BMI. A total of 1220 patients with RA who had undergone at least one or more cervical radiography and BMD assessments were identified and enrolled. We found that the association between BMD and ADI (beta, -0.029; 95% CI, -0.059 to 0.002; p = 0.070) fell short of achieving statistical significance. However, the ADI showed a 3.6% decrease per 1 BMI increase in the osteoporosis group (beta, -0.036; 95% CI, -0.061 to -0.011; p = 0.004). The osteopenia and osteoporosis groups showed about a 1.5-fold and a 1.8-fold increased risk of AAS occurrence among the first tertile of the BMI group. Our study showed a possible association between lower BMD and AAS occurrence in patients with RA with lower BMI. Further studies are needed to confirm our findings.
URI
https://link.springer.com/article/10.1007%2Fs00198-017-3972-9https://repository.hanyang.ac.kr/handle/20.500.11754/113358
ISSN
0937-941X; 1433-2965
DOI
10.1007/s00198-017-3972-9
Appears in Collections:
COLLEGE OF MEDICINE[S](의과대학) > MEDICINE(의학과) > Articles
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