Bone mineral density and clinical hand osteoarthritis in elderly men and women: the Rancho Bernardo study

Many studies have found increased bone mineral density (BMD) in patients with osteoarthritis (OA). As a result, clinicians may not consider osteoporosis in patients with OA. We examined the relation between hand OA and BMD levels among 1779 community-dwelling, ambulatory white adults aged 50-96 years.

BMD was measured by dual energy x-ray absorptiometry at the hip, lateral and anteroposterior (AP) lumbar spine, and total body. Both hands of each subject were systematically examined for bony enlargement, swelling, and deformity.

Using the American College of Rheumatology criteria for epidemiologic studies, the clinical diagnosis of hand OA was made in 6.6% of men and 14.5% of women. In women, BMD measurements adjusted for age, body mass index, smoking, alcohol, exercise, and current estrogen use were significantly lower only at the hip in those with versus those without hand OA. In contrast, men with hand OA had higher multiply-adjusted mean BMD levels at all sites compared to those without hand OA. These differences were statistically significant only at the AP spine; the absent difference for lateral spine BMD suggests that degenerative changes may explain the higher AP spine BMD levels. Patterns in both men and women were similar in those with isolated hand OA or hand OA in the presence of knee or hip OA.

OA was not associated with increased BMD levels in men or women. Contrary to expectations the only significant difference was that women with hand OA had lower hip BMD. Thus evaluation for osteoporosis should not be overlooked in women with hand OA.