患有炎性关节炎的年轻人的骨健康：低骨密度相关因素的评估

摘要(中文译文)

评估患有炎症性关节炎的年轻成人的骨密度（BMD）。42%的患者被检出低骨密度，与男性性别、较低的身体质量指数（BMI）、较慢的步速、较高的红细胞沉降率（ESR）以及长期使用糖皮质激素相关。该人群需要早期、全面的骨骼健康筛查以预防长期并发症。骨丢失及随之发生的骨折显著降低生活质量，导致残疾和过早死亡。这些问题在老年患者中常见，也与炎症性关节炎（IA）相关。IA对年轻成人（20-40岁）骨骼健康的影响文献记载甚少。本研究调查了乌克兰年轻IA患者中低骨密度（BMD）的患病率及潜在危险因素。本单中心研究纳入年龄18-40岁、患有IA（幼年特发性关节炎（JIA）、脊柱关节炎（SpA）、类风湿关节炎（RA））且病程>2年的患者，观察时间为2020年11月至2022年12月。排除标准如下：糖尿病、内置假体、全身型JIA及妊娠。采用双能X线吸收法测量BMD。低BMD定义为腰椎、全髋或股骨颈Z评分≤-2.0。进行多因素logistic回归分析，校正性别、身体质量指数（BMI）、红细胞沉降率（ESR）、步速及糖皮质激素使用时长，以评估相关因素，计算比值比（OR）及置信区间。在144例患者（81例女性，63例男性；中位年龄29岁）中，低BMD的患病率为42%（61/144）：JIA中为42%，SpA中为31%，RA中为26%。在校正后的多因素模型中，低BMD与男性性别（OR=11.5，p<0.001）、较低BMI（OR=0.74，p<0.001）、较高ESR（OR=1.10，p<0.001）、较慢步速（OR=0.02，p<0.001）及较长糖皮质激素使用时长（OR=1.03，p=0.003）相关。我们的研究揭示了乌克兰年轻IA患者中低BMD的高患病率，与疾病相关因素密切相关。该状况是多因素的，并与特定的临床特征相关，包括男性性别、较低BMI、体力活动能力下降、较高炎症水平及长期使用糖皮质激素，凸显了全面筛查和管理的必要性。

Abstract

To evaluate bone mineral density (BMD) in young adults with inflammatory arthritis. Low BMD was detected in 42% of patients, associated with male sex, lower BMI, slower gait speed, higher ESR, and prolonged glucocorticoids. This population requires early, comprehensive bone health screening to prevent long-term complications. Bone loss and consequent fractures significantly reduce quality of life, causing disability and premature mortality. These issues, common in elderly patients, are also linked to inflammatory arthritis (IA). The impact of IA on bone health in young adults (20-40 years) is poorly documented. This study investigated the prevalence of low bone mineral density (BMD) and potential risk factors in young adults with IA in Ukraine. Patients aged 18-40 with IA (juvenile idiopathic arthritis (JIA), spondyloarthritis (SpA), rheumatoid arthritis (RA)) and disease duration > 2 years, observed between November 2020 and December 2022, were included in this mono-centric study. Exclusion criteria are as follows: diabetes mellitus, endoprosthesis, systemic JIA, and pregnancy. BMD was measured using dual-energy X-ray absorptiometry. Low BMD was defined as a Z-score ≤ -2.0 at the lumbar spine, total hip, or femoral neck. Multivariable logistic regression, adjusted for sex, body mass index (BMI), erythrocyte sedimentation rate (ESR), gait speed, and duration of glucocorticoid use, was performed to evaluate associated factors, calculating odds ratios (OR) with confidence intervals. Among 144 patients (81 females, 63 males; median age 29 years), the prevalence of low BMD was 42% (61/144): 42% in JIA, 31% in SpA, and 26% in RA. In the adjusted multivariable model, low BMD was associated with male sex (OR = 11.5, p < 0.001), lower BMI (OR = 0.74, p < 0.001), higher ESR (OR = 1.10, p < 0.001), slower gait speed (OR = 0.02, p < 0.001), and longer duration of glucocorticoid use (OR = 1.03, p = 0.003). Our study revealed a high prevalence of low BMD among young patients with IA in Ukraine, closely linked to disease-related factors. This condition is multifactorial and associated with a specific clinical profile, including male sex, lower BMI, reduced physical performance, higher inflammation, and prolonged glucocorticoid use, highlighting the need for comprehensive screening and care.

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