Bone mineral density, trabecular bone score, and uric acid in patients with rheumatoid arthritis

Objective: to assess bone mineral density (BMD), trabecular bone score (TBS), and their relationship with serum uric acid (UA) levels in women with rheumatoid arthritis (RA).

Material and methods. The study included 165 women with confirmed RA (median age 63.0 [54.0; 68.0] years). All participants underwent clinical and laboratory evaluation, including serum UA level measurement and dual-energy X-ray absorptiometry (DXA) to assess BMD at the lumbar spine (LI-IV), femoral neck (FN), and total hip (TH). TBS was determined for all patients based on LI-IV BMD measurements.

Results and discussion. The mean UA level was 265.9±73.2 μmol/L. A positive correlation was observed between UA level and BMD at the TH (r=0.18, p=0.023), and a negative correlation was found between UA level and TBS (r=-0.25, p=0.001). In multivariate regression analysis, a significant independent association of UA level with both BMD across all measured sites and TBS was identified in postmenopausal women (p<0.05). No significant associations were observed in premenopausal women. Conclusion. In postmenopausal women with RA, serum UA levels showed a positive independent association with BMD and a negative association with TBS. No such relationship was observed in women of reproductive age. Keywords: bone mineral density; trabecular bone score; uric acid; rheumatoid arthritis> < 0.05). No significant associations were observed in premenopausal women.

Conclusion. In postmenopausal women with RA, serum UA levels showed a positive independent association with BMD and a negative association with TBS. No such relationship was observed in women of reproductive age.

1. Harvey NC, Glüer CC, Binkley N, et al. Trabecular bone score (TBS) as a new complementary approach for osteoporosis evaluation in clinical practice. Bone. 2015 Sep:78: 216-24. doi: 10.1016/j.bone.2015.05.016. Epub 2015 May 16.

2. Boutaibi H, Azzouzi H, Chennouf F, Ichchou L. Association between trabecular bone score, 10-year probability risk for fracture, and vertebral fractures in rheumatoid arthritis. Bone Rep. 2024 Sep 23:23:101806. doi: 10.1016/j.bonr.2024.101806. eCollection 2024 Dec.

3. Kim D, Cho SK, Kim JY, et al. Association between trabecular bone score and risk factors for fractures in Korean female patients with rheumatoid arthritis. Mod Rheumatol. 2016 Jul;26(4):540-5. doi: 10.3109/14397595.2015.1101212. Epub 2015 Nov 7.

4. Lee KA, Kim HJ, Kim HS. Comparison of predictive value of FRAX, trabecular bone score, and bone mineral density for vertebral fractures in systemic sclerosis: A cross-sectional study. Medicine (Baltimore). 2023 Jan 13;102(2):e32580. doi: 10.1097/MD.0000000000032580.

5. Chen F, Wang Y, Guo Y, et al. Specific higher levels of serum uric acid might have a protective effect on bone mineral density within a Chinese population over 60 years old: a cross-sectional study from northeast China. Clin Interv Aging. 2019 Jun 12:14:1065-1073. doi: 10.2147/CIA.S186500. eCollection 2019.

6. Wang R, Gao Y, Wang P, et al. Association between serum uric acid and bone mineral density in males from NHANES 2011-2020. Sci Rep. 2024 Feb 21;14(1):4292. doi: 10.1038/s41598-024-52147-8.

7. Lin KM, Lu CL, Hung KC, et al. The Paradoxical Role of Uric Acid in Osteoporosis. Nutrients. 2019 Sep 5;11(9):2111. doi: 10.3390/nu11092111.

8. Robles-Rivera K, Argoty-Pantoja AD, Hidalgo-Bravo A, et al. Uric Acid Levels Are Associated with Bone Mineral Density in Mexican Populations: A Longitudinal Study. Nutrients. 2022 Oct 12;14(20):4245. doi: 10.3390/nu14204245.

9. Li Y, Tan J, Tian J, et al. Cross-sectional analysis of the correlation between serum uric acid and trabecular bone score: NHANES 2005–2008. Sci Rep. 2023 Dec 6;13(1):21546. doi: 10.1038/s41598-023-48739-5.

10. McCloskey EV, Oden A, Harvey NC, et al. A Meta-Analysis of Trabecular Bone Score in Fracture Risk Prediction and Its Relationship to FRAX. J Bone Miner Res. 2016 May;31(5):940-8. doi: 10.1002/jbmr.2734. Epub 2015 Nov 19.

11. Hermann S, Palmowski A, Hermann KGA, et al. Elevated uric acid is associated with a low bone mineral density in pre- but not postmenopausal women with rheumatoid arthritis: a pilot study. Rheumatol Int. 2024 Nov;44(11): 2497-2504. doi: 10.1007/s00296-024-05655-9. Epub 2024 Jul 29.

12. Lee HN, Kim A, Kim Y, et al. Higher serum uric acid levels are associated with reduced risk of hip osteoporosis in postmenopausal women with rheumatoid arthritis. Medicine (Baltimore). 2020 Jun 12;99(24):e20633. doi: 10.1097/MD.0000000000020633.

13. Kim S, Lee S, Kwon H. Association between serum uric acid level and bone mineral density in men more than 50 years of age. Front Endocrinol (Lausanne). 2023 Nov 30:14:1259077. doi: 10.3389/fendo.2023.1259077. eCollection 2023.

14. Cheng P, Qi HM, Di WJ, et al. Establishment of TBS reference plots and correlation between TBS and BMD in healthy mainland Chinese women. Arch Osteoporos. 2016:11:5. doi: 10.1007/s11657-015-0254-z. Epub 2016 Jan 11.

15. Leslie WD, Krieg MA, Hans D; Manitoba Bone Density Program. Clinical factors associated with trabecular bone score. J Clin Densitom. 2013 Jul-Sep;16(3):374-379. doi: 10.1016/j.jocd.2013.01.006. Epub 2013 Feb 26.

16. Senosi MR, Fathi HM, Baki NMA, et al. Bone mineral density, vitamin D receptor (VDR) gene polymorphisms, fracture risk assessment (FRAX), and trabecular bone score (TBS) in rheumatoid arthritis patients: connecting pieces of the puzzle. Clin Rheumatol. 2022 May;41(5):1333-1342. doi: 10.1007/s10067-022-06048-8. Epub 2022 Jan 19.