MedWire News: Dual-energy X-ray absorptiometry (DXA) is underused in men with rheumatoid arthritis (RA), say researchers who highlight the risk for osteoporosis in this population.
The findings suggest that “males with RA are at risk for osteoporosis, and efforts to improve and optimize DXA screening are warranted,” say J Steuart Richards (Washington DC Veterans Affairs Medical Center, USA) and co-workers.
The team examined DXA use in 795 men enrolled in the Veterans Affairs RA Registry who were aged an average of 65.4 years and had been diagnosed with RA a mean of 13.0 years earlier. All men completed the Osteoporosis Self-Assessment Tool (OST) index, which examines the risk for osteoporosis using age and weight.
Overall, 35.5% of men had undergone DXA, and its use was associated with younger age, lower mean OST index score, and use of steroid treatment.
A low bone mass, defined as a T-score of less than -1, was detected in 73% of men who underwent DXA. Normal bone mineral density (BMD) was detected in 37% of men with a low-risk OST score compared with 5.6% of those who had a high-risk OST score.
Thus, there was a significant but modest correlation between BMD an OST index, the researchers report in the Journal of Clinical Densitometry.
The OST index was best at identifying low BMD in non-Hispanic White men, men older than 60 years, and smokers, but no OST score had higher than 80% sensitivity or specificity for low BMD.
“Low bone mass was associated with many risk factors previously recognized – increased age, increased RA disease activity, corticosteroid use, and smoking; all of these were prevalent in males with RA,” Richard et al note.
“We were unable to prove that the OST index could be used to reliably screen for osteoporosis in males in our cohort, and the retrospective design of our study may have contributed to the negative result.”
They therefore conclude: “A prospective study of the OST index and other screening measures is warranted to improve the management of osteoporosis in males with RA and strategies should be developed to enhance compliance with current guidelines.”
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