Bone mineral density and androgenic status in men with rheumatoid arthritis


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Abstract

Background. The development of osteoporosis (OP) is one of the most frequent and serious complications of rheumatoid arthritis (RA) and largely determines its unfavorable course and prognosis associated with a high incidence of osteoporotic fractures and death after their development. Data on the state of bone mineral density (BMD) in men with RA are still scarce and highly controversial. Objective. Assessment of the state of BMD and indicators of androgenic status in male patients with RA over 50 years of age. Methods. 96 male patients aged 59 [54; 64.75] years with a reliable diagnosis of RA and a disease duration of more than one year were examined. The control group consisted of 30 apparently healthy men of comparable age (p>0.05). Assessment of the androgenic status included the determination of blood serum total testosterone and sex hormone binding globulin (SHBG) levels, followed by the calculation of the androgenic activity index, free and bioavailable testosterone levels. BMD at the lumbar spine, femoral neck and proximal femur as a whole was assessed by dual-energy X-ray absorptiometry (DXA) (Stratos dR DMS densitometer, France). All patients included in the study have given written informed consent for participation. Results. Male RA patients showed a statistically significant increase in SHBG level and a decrease in free and bioavailable testosterone levels. In 49.2% of men with RA, the increase in SHBG was higher than normal values. Patients with seronegative RA were more likely to have a decrease in total testosterone levels. Androgen deficiency was verified in 50.8% of patients of the study group. Osteopenic syndrome was diagnosed in 71.9% of patients with RA: in 11.5% of cases, the decrease in BMD in at least one area corresponded to OP and in 60.4% of cases - to osteopenia. Androgen deficiency was detected in 70% of patients with OP, in 50% of patients with osteopenia, and in 33.3% of men with normal BMD. In patients with androgenic deficiency, the BMD of the lumbar spine was statistically significantly lower than in patients with normal indicators of androgenic status (0.85 [0.80; 0.96] g/cm2 and 0.94 [0.84; 1.08] g/cm2, respectively, p=0.036). Conclusion. Thus, a decrease in BMD in male patients with RA has a high prevalence and requires timely diagnosis in order to determine the tactics of treatment and prevention of low-energy fractures. Androgen deficiency is an additional risk factor for bone mass loss in men with RA, which makes the assessment of androgenic status an additional important examination.

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About the authors

Artem A. Kondrashov

Pirogov Russian National Research Medical University

Email: kaartem@gmail.com
Teaching Assistant at the Department of Faculty Therapy n.a. Academician A.I. Nesterov, Faculty of General Medicine Moscow, Russia

N. A Shostak

Pirogov Russian National Research Medical University

Moscow, Russia

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