Background
Methods
Study design, sample size and population
Data collection, procedures, and tools
Blood samples and DXA tests
Definitions
Data processing and statistical analysis
Results
Baseline characteristics of patients
HC | RA | Pa | OA | Pa | SLE | Pa | SSc | Pa | |
N = 302 | N = 559 | N = 198 | N = 206 | N = 53 | |||||
Age, years, median [IQR] | 63.0 [53.2;72.8] | 58.0 [50.0;66.0] | < 0.001 | 61.0 [53.0;69.8] | 0.188 | 45.0 [35.0;54.0] | < 0.001 | 54.0 [45.0;59.0] | < 0.001 |
Disease durationb, years, median [IQR] | NA | 5.6 [2.0;12.0] | NA | 4.0 [1.5;10.0] | NA | 3.0 [1.0;7.0] | NA | 3.5 [2.0;7.0] | NA |
Age groups, years, n(%) | < 0.001 | 0.008 | < 0.001 | 0.019 | |||||
< 30 | 19 (6.3) | 10 (1.8) | 2 (1.0) | 37 (18.0) | 2 (3.8) | ||||
31–39 | 9 (3.0) | 24 (4.2) | 4 (2.0) | 38 (18.4) | 5 (9.4) | ||||
40–49 | 25 (8.3) | 105 (18.8) | 29 (14.6) | 50 (24.3) | 10 (18.9) | ||||
≥ 50 | 249 (82.5) | 420 (75.1) | 163 (82.3) | 81 (39.3) | 36 (67.9) | ||||
BMI, Kg/m2, mean (SD) | 22.5 (3.7) | 21.9 (3.5) | 0.321 | 24.1 (4.0) | < 0.001 | 22.0 (3.6) | 0.085 | 21.8 (3.0) | 0.935 |
Gender, female, n(%) | 229 (75.8) | 450 (80.5) | 0.173 | 165 (83.3) | 0.087 | 187 (90.8) | < 0.001 | 38 (71.7) | 0.676 |
Menopause status of female, n(%) | 0.01 | 0.277 | < 0.001 | 0.067 | |||||
Post-menopause | 202 (88.2) | 359 (79.8) | 139 (84.2) | 91 (48.7) | 29 (76.3) | ||||
Early menopause, age ≤ 45 | 31 (15.3) | 48 (13.4) | 18 (12.9) | 18 (19.8) | 4 (13.8) | ||||
HC | AS | Pa | pSS | Pa | Gout | Pa | MCTD | Pa | |
N = 302 | N = 128 | N = 98 | N = 111 | N = 45 | |||||
Age, years, median [IQR] | 63.0 [53.2;72.8] | 36.5 [27.0;45.2] | < 0.001 | 54.5 [46.0;60.0] | < 0.001 | 61.0 [48.0;72.0] | 0.269 | 56.0 [46.0;62.0] | < 0.001 |
Disease durationb, years, median [IQR] | NA | 6.5 [3.0;12.0] | NA | 1.2 [0.6;2.3] | NA | 6.0 [3.0;11.5] | NA | 1.3 [0.5;4.5] | NA |
Age groups, years, n(%) | < 0.001 | 0.003 | 0.006 | 0.003 | |||||
< 30 | 19 (6.3) | 42 (32.8) | 5 (5.1) | 5 (4.5) | 2 (4.4%) | ||||
31–39 | 9 (3.0) | 30 (23.4) | 10 (10.2) | 7 (6.31) | 2 (4.4) | ||||
40–49 | 25 (8.3) | 36 (28.1) | 17 (17.3) | 22 (19.8) | 13 (28.9) | ||||
≥ 50 | 249 (82.5) | 20 (15.6) | 66 (67.3) | 77 (69.4) | 28 (62.2) | ||||
BMI, Kg/m2, mean (SD) | 22.5 (3.7) | 22.0 (4.2) | 0.865 | 21.3 (2.9) | 0.094 | 24.1 (3.3) | 0.003 | 21.6 (3.0) | 0.79 |
Gender, female, n(%) | 229 (75.8) | 40 (31.2) | < 0.001 | 91 (92.9) | 0.001 | 18 (16.2) | < 0.001 | 39 (86.7) | 0.197 |
Menopause status of female, n(%) | < 0.001 | 0.001 | 0.734 | 0.001 | |||||
Post-menopause | 202 (88.2) | 9 (22.5) | 66 (72.5) | 17 (94.4) | 26 (66.7) | ||||
Early menopause, age ≤ 45 | 31 (15.3) | 3 (33.3) | 5 (7.6) | 5 (29.4) | 7 (26.9) |
Characteristic | Results |
---|---|
Former or current smoking, n(%) | 151 (8.9) |
Always drinking, n(%) | 107 (6.3) |
Comorbidities, n(%) | |
Diabetes Mellitus | 203 (11.9) |
Hypertension | 424 (24.9) |
Dyslipidemia | 284 (16.7) |
Hyperuricemia | 395 (23.2) |
Hypovitaminosis D | 1167 (68.6) |
Complications, n(%) | |
Femoral head necrosis | 28 (1.6) |
Osteoporotic fracture | 75 (4.4) |
Medication history, yes, n(%) | |
Former or current chronic oral Glucocorticoid therapy | 713 (41.9) |
NSAIDs | 799 (47.0) |
cDMARDs | |
1 Type | 261 (15.5) |
2 Types | 336 (20.0) |
3 Types | 124 (7.4) |
bDMARDs | 112 (6.6) |
Blood calcium level, mean (SD) | 2.6 (7.8) |
Serum phosphate level, mean (SD) | 1.3 (2.6) |
Serum creatinine level, median [IQR] | 62.0 [53.0, 75.3] |
Serum Uric acid level, n(%) | |
< 360 | 1068 (63.6) |
360–419 | 249 (14.8) |
420 ~ 539 | 243 (14.5) |
≥540 | 118 (7.0) |
CRP, median [IQR] | 7.1 [1.5, 30.9] |
ESR, median [IQR] | 34.5 [15.0, 66.0] |
Serum 25(OH)D3 level, mean (SD) | 64.0 (26.3) |
Elevated inflammatory markers, n(%) | |
ESR | 972 (63.8) |
CRP | 729 (47.8) |
Prevalence of impaired BMD in two age-stratified population
The odds ratio for bone loss in rheumatic patients
Variables | ‘Score below the expected range for age’ | |
---|---|---|
OR (95% CIs) | P | |
Former or current chronic GC usage | N = 64 | |
Agea | 0.96 [0.93;0.99] | 0.014 |
Disease durationb | 1.07 [1.01;1.13] | 0.025 |
BMI, Kg/m2 | ||
< 18.5 (underweight) | 3.57 [1.55;8.43] | 0.003 |
18.5–23.9 (normal) | Ref. | Ref. |
24–27.9 (overweight) | 0.83 [0.34;1.89] | 0.674 |
≥ 28(obese) | 4.99 [1.38;20.9] | 0.014 |
Gender, compared with male | ||
Female | 0.38 [0.17;0.83] | 0.015 |
Medical history | ||
Diabetes Mellitus | 1.38 [0.26;6.05] | 0.68 |
Hypertension | 2.33 [0.61;8.96] | 0.211 |
Dyslipidemia | 0.86 [0.26;2.44] | 0.79 |
Hyperuricemia | 1.36 [0.58;3.03] | 0.466 |
Former or current smokers | 0.86 [0.17;3.15] | 0.825 |
Regular drinking | 0.49 [0.02;3.26] | 0.503 |
Hypovitaminosis D | 1.23 [0.65;2.37] | 0.525 |
CRP elevated | 1.76 [0.97;3.23] | 0.063 |
ESR elevated | 1.57 [0.83;3.08] | 0.17 |
Non-GC usage | N = 81 | |
Agea | 0.94 [0.92;0.97] | < 0.001 |
Disease durationb | 1.00 [0.95;1.04] | 0.866 |
BMI, Kg/m2 | ||
< 18.5 (underweight) | 3.53 [1.61;8.07] | 0.001 |
18.5–23.9 (normal) | Ref. | Ref. |
24–27.9 (overweight) | 0.81 [0.39;1.65] | 0.568 |
≥ 28(obese) | 0.09 [0.00;0.45] | 0.001 |
Gender, compared with male | ||
Female | 0.39 [0.22;0.68] | 0.001 |
Medical history | ||
Diabetes Mellitus | 0.22 [0.01;1.28] | 0.102 |
Hypertension | 0.65 [0.22;1.69] | 0.389 |
Dyslipidemia | 0.94 [0.37;2.21] | 0.883 |
Hyperuricemia | 1.80 [0.96;3.38] | 0.067 |
Former or current smokers | 1.50 [0.64;3.46] | 0.342 |
Regular drinking | 0.58 [0.18;1.60] | 0.306 |
Hypovitaminosis D | 1.91 [1.03;3.62] | 0.039 |
CRP elevated | 1.13 [0.65;1.97] | 0.676 |
ESR elevated | 0.86 [0.49;1.51] | 0.591 |
Variables | Osteopenia | Osteoporosis | ||
---|---|---|---|---|
OR (95% CIs) | P | OR (95% CIs) | P | |
Former or current chronic GC therapy | N = 163 | N = 276 | ||
Agea | 1.07 [1.03;1.11] | 0.001 | 1.13 [1.08;1.18] | < 0.001 |
Disease durationb | 1.06 [1.00;1.12] | 0.033 | 1.05 [1.00;1.11] | 0.052 |
BMI, Kg/m2 | ||||
< 18.5 (underweight) | 1.74 [0.44;12.6] | 0.469 | 2.98 [0.83;20.7] | 0.102 |
18.5–23.9 (normal) | Ref. | Ref. | Ref. | Ref. |
24–27.9 (overweight) | 0.54 [0.26;1.11] | 0.092 | 0.30 [0.15;0.61] | 0.001 |
≥ 28(obese) | 0.55 [0.18;1.93] | 0.329 | 0.17 [0.05;0.65] | 0.011 |
Gender, compared with male | ||||
Female | 3.08 [1.55;6.15] | 0.001 | 3.52 [1.83;6.74] | < 0.001 |
Menopause status | ||||
Post-menopause | Ref. | Ref. | Ref. | Ref. |
Early menopause, age ≤ 45 | 0.96 [0.32;3.65] | 0.943 | 1.09 [0.39;4.02] | 0.877 |
Medical history | ||||
Diabetes Mellitus | 0.84 [0.34;2.28] | 0.709 | 0.71 [0.31;1.88] | 0.471 |
Hypertension | 1.31 [0.62;3.01] | 0.492 | 1.17 [0.57;2.63] | 0.675 |
Dyslipidemia | 0.29 [0.13;0.66] | 0.003 | 0.45 [0.22;0.93] | 0.031 |
Hyperuricemia | 0.58 [0.27;1.30] | 0.178 | 0.42 [0.20;0.92] | 0.032 |
Former or current smokers | 0.42 [0.16;1.15] | 0.089 | 0.44 [0.19;1.12] | 0.083 |
Regular drinking | 0.48 [0.13;1.97] | 0.284 | 0.65 [0.22;2.40] | 0.477 |
Hypovitaminosis D | 2.49 [1.29;4.90] | 0.007 | 3.95 [2.09;7.58] | < 0.001 |
CRP elevation | 1.15 [0.60;2.22] | 0.673 | 1.60 [0.85;2.99] | 0.143 |
ESR elevation | 1.36 [0.68;2.67] | 0.374 | 2.49 [1.27;4.80] | 0.009 |
Non-GC therapy | N = 176 | N = 239 | ||
Agea | 1.12 [1.09;1.16] | < 0.001 | 1.16 [1.12;1.20] | < 0.001 |
Disease durationb | 1.02 [0.98;1.06] | 0.311 | 1.02 [0.99;1.06] | 0.128 |
BMI, Kg/m2 | ||||
< 18.5 (underweight) | 0.86 [0.25;3.54] | 0.826 | 2.04 [0.74;7.35] | 0.178 |
18.5–23.9 (normal) | Ref. | Ref. | Ref. | Ref. |
24–27.9 (overweight) | 0.70 [0.40;1.23] | 0.217 | 0.29 [0.16;0.51] | < 0.001 |
≥ 28(obese) | 0.54 [0.26;1.14] | 0.104 | 0.29 [0.14;0.60] | 0.001 |
Gender, compared with male | ||||
Female | 1.02 [0.48;2.09] | 0.949 | 9.34 [5.51;16.2] | < 0.001 |
Menopause status | ||||
Post-menopause | Ref. | Ref. | Ref. | Ref. |
Early menopause, age ≤ 45 | 1.70 [0.43;12.3] | 0.485 | 1.09 [0.39;4.02] | 0.877 |
Medical history | ||||
Diabetes Mellitus | 0.97 [0.50;1.93] | 0.921 | 1.02 [0.55;1.99] | 0.939 |
Hypertension | 1.58 [0.92;2.75] | 0.098 | 1.17 [0.69;2.00] | 0.566 |
Dyslipidemia | 0.87 [0.47;1.64] | 0.651 | 0.60 [0.33;1.13] | 0.114 |
Hyperuricemia | 0.66 [0.37;1.16] | 0.146 | 0.54 [0.31;0.93] | 0.027 |
Former or current smokers | 0.33 [0.16;0.66] | 0.002 | 0.35 [0.18;0.66] | 0.001 |
Regular drinking | 0.29 [0.13;0.61] | 0.001 | 0.24 [0.12;0.51] | < 0.001 |
Hypovitaminosis D | 0.88 [0.51;1.50] | 0.639 | 1.02 [0.60;1.69] | 0.95 |
CRP elevation | 0.77 [0.46;1.26] | 0.292 | 0.78 [0.48;1.25] | 0.294 |
ESR elevation | 0.83 [0.49;1.40] | 0.492 | 1.48 [0.87;2.48] | 0.146 |