Interaction of therapy on bone mineral density in male and female patients with rheumatoid arthritis
Summary. Objective — to assess the effect of therapy on bone mineral density (BMD) in male and femail patients with rheumatoid arthritis (RA). Object and research methods. The study was performed on 145 RA patients aged 18–72 years: 117 (80.7%) women (mean age 45.4±13.0 years) and 28 (19.3%) men (mean age 46.4±16.9 years), who received mono- or combination therapy by methotrexate (MT), glucocorticoids (GC), and biological agents (BA). The study did not include patients used any other disease-modifying and osteotropic drugs. Patients were divided on groups, depending on received therapy. MT received 60.7% men, 87.0% women in reproductive (RP) and 85.4% — in postmenopausal period (PM); GK — 64.3% men, 62.3% women RP and 77.1% — PM; BA — 46.4 and 33.3%, respectively; male patients did not receive BA. Results. GC in women with RA significantly decrease BMD in all parts of skeleton, especially hip in women RP. MT treatment associated with decreased BMD on lumbar spine (LI–LIV) and total hip in women PM, BA protect bone mass (BM) lost on total hip and ultradistal part of forearm. GK on women RA is required to special attention for BM monitoring at total hip and ultradistal part of forearm. In men with RA, the site-specific dose-dependent GC effect is associated with standardization GC dose: ≥5 mg/day — with BMD LI–LIV spine and duration of GC administration on dose ≥5 mg/day — with BMD femur neck and middle part of forearm. The GC using in RA patients leads to systemic (reduction in BMD on different parts of the skeleton) and local (erosions and progression of the Ro-stage) loss of BM on male and femaile patients.
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