Establishment of age- and sex-adjusted reference data for hand bone mass and investigation of hand bone loss in patients with rheumatoid arthritis treated in clinical practice: an observational study from the DANBIO registry and the Copenhagen Osteoarthritis Study

Lykke Midtbøll Ørnbjerg; Mikkel Østergaard; Trine Jensen; Lars Hyldstrup; Pernille Bach-Mortensen; Pernille Bøyesen; Anja Thormann; Ulrik Tarp; Wolfgang Peter Bøhme; Hanne Lindegaard; Uta Engling Poulsen; Anette Schlemmer; Niels Graudal; Anne Rødgaard; Jakob Espesen; Gina Birgitte Kollerup; Bente Glintborg; Ole Rintek Madsen; Dorte Vendelbo  Jensen; Merete Lund Hetland

doi:10.1186/s13075-016-0952-y

Establishment of age- and sex-adjusted reference data for hand bone mass and investigation of hand bone loss in patients with rheumatoid arthritis treated in clinical practice: an observational study from the DANBIO registry and the Copenhagen Osteoarthritis Study

Lykke Midtbøll Ørnbjerg, Mikkel Østergaard, Trine Jensen, Lars Hyldstrup, Pernille Bach-Mortensen, Pernille Bøyesen, Anja Thormann, Ulrik Tarp, Wolfgang Peter Bøhme, Hanne Lindegaard, Uta Engling Poulsen, Anette Schlemmer, Niels Graudal, Anne Rødgaard, Jakob Espesen, Gina Birgitte Kollerup, Bente Glintborg, Ole Rintek Madsen, Dorte Vendelbo Jensen, Merete Lund Hetland

Department of Clinical Medicine

3 Citations (Scopus)

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Abstract

Background: Rheumatoid arthritis is characterised by progressive joint destruction and loss of periarticular bone mass. Hand bone loss (HBL) has therefore been proposed as an outcome measure for treatment efficacy. A definition of increased HBL adjusted for age- and sex-related bone loss is lacking. In this study, we aimed to: 1) establish reference values for normal hand bone mass (bone mineral density measured by digital x-ray radiogrammetry (DXR-BMD)); and 2) examine whether HBL is normalised in rheumatoid arthritis patients during treatment with tumour necrosis factor alpha inhibitors (TNFI). Methods: DXR-BMD was measured from hand x-rays in a reference cohort (1485 men/2541 women) without arthritis randomly selected from an urban Danish population. Sex- and age-related HBL/year was estimated. DXR-BMD was measured in rheumatoid arthritis patients (n = 350: at start of TNFI, and ~2 years after TNFI start), of which 135 patients had three x-rays (~2 years prior to TNFI, at start of TNFI, and ~2 years after TNFI start). Individual HBL/year prior to and during TNFI was calculated and compared to reference values. Results: Estimated HBL/year varied strongly with age and sex. Compared to the reference values, 75 % of 135 patients had increased HBL prior to TNFI treatment and 59 % had increased HBL during TNFI treatment (p = 0.17, Chi-squared). In 38 % (38/101) of patients with increased HBL, HBL was normalised during TNFI treatment, whereas 47 % (16/34) of patients with normal HBL prior to TNFI had increased HBL during TNFI treatment. In the 350 patients, increased HBL during TNFI was associated with time-averaged 28-joint disease activity score (odds ratio 1.69 (95 % Confidence Interval 1.34-2.15)/unit increase, p < 0.001), and patients in time-averaged remission had lower HBL than patients without remission (0.0032 vs. 0.0058 g/cm²/year; p < 0.001, Mann-Whitney). Conclusions: We established age- and sex-specific reference values for DXR-BMD in a large cohort without arthritis. HBL was increased in the majority of rheumatoid arthritis patients initiating TNFI in clinical practice, and only normalised in a minority during TNFI.

Original language	English
Article number	53
Journal	Arthritis Research & Therapy
Volume	18
Number of pages	11
ISSN	1478-6362
DOIs	https://doi.org/10.1186/s13075-016-0952-y
Publication status	Published - 24 Feb 2016

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Establishment of age- and sex-adjusted reference data for hand bone mass and investigation of hand bone loss in patients with rheumatoid arthritis treated in clinical practice: an observational study from the DANBIO registry and the Copenhagen Osteoarthritis StudyFinal published version, 840 KBLicence: CC BY

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Ørnbjerg, L. M., Østergaard, M., Jensen, T., Hyldstrup, L., Bach-Mortensen, P., Bøyesen, P., Thormann, A., Tarp, U., Bøhme, W. P., Lindegaard, H., Poulsen, U. E., Schlemmer, A., Graudal, N., Rødgaard, A., Espesen, J., Kollerup, G. B., Glintborg, B., Madsen, O. R., Jensen, D. V., & Hetland, M. L. (2016). Establishment of age- and sex-adjusted reference data for hand bone mass and investigation of hand bone loss in patients with rheumatoid arthritis treated in clinical practice: an observational study from the DANBIO registry and the Copenhagen Osteoarthritis Study. Arthritis Research & Therapy, 18, Article 53. https://doi.org/10.1186/s13075-016-0952-y

Establishment of age- and sex-adjusted reference data for hand bone mass and investigation of hand bone loss in patients with rheumatoid arthritis treated in clinical practice: an observational study from the DANBIO registry and the Copenhagen Osteoarthritis Study. / Ørnbjerg, Lykke Midtbøll; Østergaard, Mikkel; Jensen, Trine et al.
In: Arthritis Research & Therapy, Vol. 18, 53, 24.02.2016.

Research output: Contribution to journal › Journal article › Research › peer-review

Ørnbjerg, LM, Østergaard, M, Jensen, T, Hyldstrup, L, Bach-Mortensen, P, Bøyesen, P, Thormann, A, Tarp, U, Bøhme, WP, Lindegaard, H, Poulsen, UE, Schlemmer, A, Graudal, N, Rødgaard, A, Espesen, J, Kollerup, GB, Glintborg, B, Madsen, OR, Jensen, DV & Hetland, ML 2016, 'Establishment of age- and sex-adjusted reference data for hand bone mass and investigation of hand bone loss in patients with rheumatoid arthritis treated in clinical practice: an observational study from the DANBIO registry and the Copenhagen Osteoarthritis Study', Arthritis Research & Therapy, vol. 18, 53. https://doi.org/10.1186/s13075-016-0952-y

Ørnbjerg LM, Østergaard M, Jensen T, Hyldstrup L, Bach-Mortensen P, Bøyesen P et al. Establishment of age- and sex-adjusted reference data for hand bone mass and investigation of hand bone loss in patients with rheumatoid arthritis treated in clinical practice: an observational study from the DANBIO registry and the Copenhagen Osteoarthritis Study. Arthritis Research & Therapy. 2016 Feb 24;18:53. doi: 10.1186/s13075-016-0952-y

Ørnbjerg, Lykke Midtbøll ; Østergaard, Mikkel ; Jensen, Trine et al. / Establishment of age- and sex-adjusted reference data for hand bone mass and investigation of hand bone loss in patients with rheumatoid arthritis treated in clinical practice : an observational study from the DANBIO registry and the Copenhagen Osteoarthritis Study. In: Arthritis Research & Therapy. 2016 ; Vol. 18.

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title = "Establishment of age- and sex-adjusted reference data for hand bone mass and investigation of hand bone loss in patients with rheumatoid arthritis treated in clinical practice: an observational study from the DANBIO registry and the Copenhagen Osteoarthritis Study",

abstract = "Background: Rheumatoid arthritis is characterised by progressive joint destruction and loss of periarticular bone mass. Hand bone loss (HBL) has therefore been proposed as an outcome measure for treatment efficacy. A definition of increased HBL adjusted for age- and sex-related bone loss is lacking. In this study, we aimed to: 1) establish reference values for normal hand bone mass (bone mineral density measured by digital x-ray radiogrammetry (DXR-BMD)); and 2) examine whether HBL is normalised in rheumatoid arthritis patients during treatment with tumour necrosis factor alpha inhibitors (TNFI). Methods: DXR-BMD was measured from hand x-rays in a reference cohort (1485 men/2541 women) without arthritis randomly selected from an urban Danish population. Sex- and age-related HBL/year was estimated. DXR-BMD was measured in rheumatoid arthritis patients (n = 350: at start of TNFI, and ~2 years after TNFI start), of which 135 patients had three x-rays (~2 years prior to TNFI, at start of TNFI, and ~2 years after TNFI start). Individual HBL/year prior to and during TNFI was calculated and compared to reference values. Results: Estimated HBL/year varied strongly with age and sex. Compared to the reference values, 75 % of 135 patients had increased HBL prior to TNFI treatment and 59 % had increased HBL during TNFI treatment (p = 0.17, Chi-squared). In 38 % (38/101) of patients with increased HBL, HBL was normalised during TNFI treatment, whereas 47 % (16/34) of patients with normal HBL prior to TNFI had increased HBL during TNFI treatment. In the 350 patients, increased HBL during TNFI was associated with time-averaged 28-joint disease activity score (odds ratio 1.69 (95 % Confidence Interval 1.34-2.15)/unit increase, p < 0.001), and patients in time-averaged remission had lower HBL than patients without remission (0.0032 vs. 0.0058 g/cm2/year; p < 0.001, Mann-Whitney). Conclusions: We established age- and sex-specific reference values for DXR-BMD in a large cohort without arthritis. HBL was increased in the majority of rheumatoid arthritis patients initiating TNFI in clinical practice, and only normalised in a minority during TNFI.",

author = "{\O}rnbjerg, {Lykke Midtb{\o}ll} and Mikkel {\O}stergaard and Trine Jensen and Lars Hyldstrup and Pernille Bach-Mortensen and Pernille B{\o}yesen and Anja Thormann and Ulrik Tarp and B{\o}hme, {Wolfgang Peter} and Hanne Lindegaard and Poulsen, {Uta Engling} and Anette Schlemmer and Niels Graudal and Anne R{\o}dgaard and Jakob Espesen and Kollerup, {Gina Birgitte} and Bente Glintborg and Madsen, {Ole Rintek} and Jensen, {Dorte Vendelbo} and Hetland, {Merete Lund}",

year = "2016",

month = feb,

day = "24",

doi = "10.1186/s13075-016-0952-y",

language = "English",

volume = "18",

journal = "Arthritis Research & Therapy",

issn = "1478-6362",

publisher = "BioMed Central",

}

TY - JOUR

T1 - Establishment of age- and sex-adjusted reference data for hand bone mass and investigation of hand bone loss in patients with rheumatoid arthritis treated in clinical practice

T2 - an observational study from the DANBIO registry and the Copenhagen Osteoarthritis Study

AU - Ørnbjerg, Lykke Midtbøll

AU - Østergaard, Mikkel

AU - Jensen, Trine

AU - Hyldstrup, Lars

AU - Bach-Mortensen, Pernille

AU - Bøyesen, Pernille

AU - Thormann, Anja

AU - Tarp, Ulrik

AU - Bøhme, Wolfgang Peter

AU - Lindegaard, Hanne

AU - Poulsen, Uta Engling

AU - Schlemmer, Anette

AU - Graudal, Niels

AU - Rødgaard, Anne

AU - Espesen, Jakob

AU - Kollerup, Gina Birgitte

AU - Glintborg, Bente

AU - Madsen, Ole Rintek

AU - Jensen, Dorte Vendelbo

AU - Hetland, Merete Lund

PY - 2016/2/24

Y1 - 2016/2/24

N2 - Background: Rheumatoid arthritis is characterised by progressive joint destruction and loss of periarticular bone mass. Hand bone loss (HBL) has therefore been proposed as an outcome measure for treatment efficacy. A definition of increased HBL adjusted for age- and sex-related bone loss is lacking. In this study, we aimed to: 1) establish reference values for normal hand bone mass (bone mineral density measured by digital x-ray radiogrammetry (DXR-BMD)); and 2) examine whether HBL is normalised in rheumatoid arthritis patients during treatment with tumour necrosis factor alpha inhibitors (TNFI). Methods: DXR-BMD was measured from hand x-rays in a reference cohort (1485 men/2541 women) without arthritis randomly selected from an urban Danish population. Sex- and age-related HBL/year was estimated. DXR-BMD was measured in rheumatoid arthritis patients (n = 350: at start of TNFI, and ~2 years after TNFI start), of which 135 patients had three x-rays (~2 years prior to TNFI, at start of TNFI, and ~2 years after TNFI start). Individual HBL/year prior to and during TNFI was calculated and compared to reference values. Results: Estimated HBL/year varied strongly with age and sex. Compared to the reference values, 75 % of 135 patients had increased HBL prior to TNFI treatment and 59 % had increased HBL during TNFI treatment (p = 0.17, Chi-squared). In 38 % (38/101) of patients with increased HBL, HBL was normalised during TNFI treatment, whereas 47 % (16/34) of patients with normal HBL prior to TNFI had increased HBL during TNFI treatment. In the 350 patients, increased HBL during TNFI was associated with time-averaged 28-joint disease activity score (odds ratio 1.69 (95 % Confidence Interval 1.34-2.15)/unit increase, p < 0.001), and patients in time-averaged remission had lower HBL than patients without remission (0.0032 vs. 0.0058 g/cm2/year; p < 0.001, Mann-Whitney). Conclusions: We established age- and sex-specific reference values for DXR-BMD in a large cohort without arthritis. HBL was increased in the majority of rheumatoid arthritis patients initiating TNFI in clinical practice, and only normalised in a minority during TNFI.

AB - Background: Rheumatoid arthritis is characterised by progressive joint destruction and loss of periarticular bone mass. Hand bone loss (HBL) has therefore been proposed as an outcome measure for treatment efficacy. A definition of increased HBL adjusted for age- and sex-related bone loss is lacking. In this study, we aimed to: 1) establish reference values for normal hand bone mass (bone mineral density measured by digital x-ray radiogrammetry (DXR-BMD)); and 2) examine whether HBL is normalised in rheumatoid arthritis patients during treatment with tumour necrosis factor alpha inhibitors (TNFI). Methods: DXR-BMD was measured from hand x-rays in a reference cohort (1485 men/2541 women) without arthritis randomly selected from an urban Danish population. Sex- and age-related HBL/year was estimated. DXR-BMD was measured in rheumatoid arthritis patients (n = 350: at start of TNFI, and ~2 years after TNFI start), of which 135 patients had three x-rays (~2 years prior to TNFI, at start of TNFI, and ~2 years after TNFI start). Individual HBL/year prior to and during TNFI was calculated and compared to reference values. Results: Estimated HBL/year varied strongly with age and sex. Compared to the reference values, 75 % of 135 patients had increased HBL prior to TNFI treatment and 59 % had increased HBL during TNFI treatment (p = 0.17, Chi-squared). In 38 % (38/101) of patients with increased HBL, HBL was normalised during TNFI treatment, whereas 47 % (16/34) of patients with normal HBL prior to TNFI had increased HBL during TNFI treatment. In the 350 patients, increased HBL during TNFI was associated with time-averaged 28-joint disease activity score (odds ratio 1.69 (95 % Confidence Interval 1.34-2.15)/unit increase, p < 0.001), and patients in time-averaged remission had lower HBL than patients without remission (0.0032 vs. 0.0058 g/cm2/year; p < 0.001, Mann-Whitney). Conclusions: We established age- and sex-specific reference values for DXR-BMD in a large cohort without arthritis. HBL was increased in the majority of rheumatoid arthritis patients initiating TNFI in clinical practice, and only normalised in a minority during TNFI.

U2 - 10.1186/s13075-016-0952-y

DO - 10.1186/s13075-016-0952-y

M3 - Journal article

C2 - 26912229

SN - 1478-6362

VL - 18

JO - Arthritis Research & Therapy

JF - Arthritis Research & Therapy

M1 - 53

ER -