Increased bone mineral density in the lumbar spine in patients with rheumatoid arthritis during long-term observation: paradox or regularity

Introduction. Chronic inflammation in rheumatoid arthritis (RA) is one of the causes of activation of bone resorption, occurrence of erosive changes, disruption of microarchitecture, bone mineral density (BMD) decrease and increased risk of vertebral and peripheral bone fractures.
The aim – to study the dynamics of bone mineral density, vertebral deformations and degenerative changes in the lumbar spine in patients with rheumatoid arthritis during long-term prospective observation. 
Materials and methods. A prospective multi-year cohort study, the duration of which was 9.7±1.7 years, included 151 women with RA aged 53.9±9.2 years with a reliable diagnosis established at the age of 41.9±12.5 years. All patients underwent clinical, laboratory and radiological examination (X-ray densitometry of the lumbar spine (L1–L4), femoral neck (FN) and total hip (TH), X-ray morphometry of the spine using the Genant method, assessment of degenerative changes in the lumbar spine) in dynamics.
Results. A BMD decrease in FN and TH and stabilization in L1–L4 were established; in patients over 55 years of age it was an increase in BMD in L1–L4 and a decrease in FN and TH; a decrease in BMD in all studied skeletal regions in patients under 55 years of age. The appearance or increase in deformations (fractures) of the vertebrae in the thoracic spine was observed in 50 (33%) patients, in the lumbar spine – in 4 (2.6%) patients; a relationship between deformations (fractures) of the vertebrae and an increase in BMD was not established. An increase in degenerative changes in all segments of the lumbar spine was established in patients with pain and a significant increase in L1–L4 BMD. Long-term monotherapy with DMARDs, as well as with biologics, did not have a positive effect on the BMD.
Conclusions. A long-term prospective cohort study revealed stabilization of the BMD in L1–L4; its increase in the group of patients with RA over 55 years of age against the background of the appearance or intensification of the initial deformation (fractures) of the vertebrae; and an increase in degenerative changes in all segments of the lumbar spine.

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