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Article Type

Review

Abstract

Objectives The aim of this study was to measure serum undercarboxylated osteocalcin (ucOC) and bone mineral density (BMD) in premenopausal patients with rheumatoid arthritis (RA) and their correlation with each other and with disease activity. Background Osteocalcin is a molecule synthesized as a prepro-osteocalcin. After proteolytic cleavage and vitamin K-dependent carboxylation processes, it is released and circulates in the blood as carboxylated osteocalcin or ucOC. Participants and methods In total, 60 premenopausal patients with RA and 30 healthy premenopausal controls with matched age were included in this study. All patients and controls were subjected to demographic data, clinical examination, and laboratory investigations including serum level of ucOC, disease activity assessment by DAS-28 score, and BMD measurement in the lumbar spine L2–L4, hip, and distal radius by dual-energy X-ray absorptiometry equipment. Results; The level of ucOC was significantly higher in patients of RA than controls (P < 0.001). BMD in patients was found to be significantly lower than in controls in spine, femoral neck, and distal radius areas. The most frequent osteoporotic site according to Z-score was the spine (16.7%) followed by the femoral neck (8.3%) and then the distal radius (6.7%). Moreover, the commonest osteopenic site according to Z-score of -1 or less was the spine (31.7%) followed by the femoral neck (21.7%) and then (16.7%) the distal radius. This work showed that ucOC level was found to be high in premenopausal patients with RA with higher DAS values than those with lower DAS value (P < 0.001). In this work, BMD measured by dual-energy X-ray absorptiometry scan was found to be lower with higher DAS values, and vice versa. Conclusion Serum level of ucOC (which is a mirror of vitamin K deficiency) was found to be higher in premenopausal patients with RA than controls and correlated positively with disease activity and inversely with BMD measurement.

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