Abnormalities of bone mineral density and bone metabolism in Venezuelan patients with rheumatoid arthritis.

Patients with rheumatoid arthritis (RA) are at increased risk for osteoporosis and bone fractures. To our knowledge, the frequency of osteopenia and osteoporosis in patients with RA from Latin America has not been established. In this study, we have examined the bone mineral density (BMD) by dual-energy x-ray absorptiometry, as well as biochemical markers of bone metabolism, in a population of 85 Venezuelan RA patients. Twenty-seven patients (29.4%) fulfilled the World Health Organization's (WHO) criteria for either trabecular osteopenia or osteoporosis compared with 10 healthy controls (8.1%; odds ratio [OR] = 3.25; P = 0.004). In addition, 30 patients (26.4%) showed cortical osteopenia or osteoporosis compared with 5 healthy controls (4.0%; OR = 8.18; P < 0.00001). Past or concurrent use of prednisone or methotrexate was not related to decreased BMD. Rheumatoid patients showed increased serum levels of osteocalcin (P = 0.002) and 24-hour urine excretion of N-telopeptide cross-links (P = 0.03). The bone marker profiles suggest an increased bone turnover during the premenopausal stage in these patients. After menopause, a resorptive pattern seems to predominate, leading to accelerated bone mass loss in RA patients. In conclusion, Venezuelan female patients with RA may be at increased risk for osteopenia or osteoporosis, particularly after menopause. Our study supports the initiation of antiresorptive medication in Latin American premenopausal patients with RA, as in other ethnic groups, to diminish the risk of osteoporosis in the postmenopausal stage.