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OBJECTIVE: We evaluated the utility of 6 generic and 2 specific risk indices for identifying low bone mineral density (BMD) or osteoporosis in women with rheumatoid arthritis (RA); and their correlation with 10-year probability of fractures as assessed with the World Health Organization fracture risk assessment (FRAX) tool. METHODS: Mexican Mestizo women with RA were evaluated in this cross-sectional study using 6 generic indices [Simple Calculated Osteoporosis Risk Estimation (SCORE); Osteoporosis Risk Assessment Instrument (ORAI); Osteoporosis Self-Assessment Tool; Age, Body Size, No Estrogen; Osteoporosis Index of Risk (OSIRIS); and Guidelines of the US National Osteoporosis Foundation], 2 specific indices (Amsterdam and modified Amsterdam), and FRAX. BMD results on dual-energy x-ray absorptiometry (DEXA) at the lumbar spine and femoral neck were considered the "gold standard." Sensitivity, specificity, and predictive values (PV) of the indices and their correlations with FRAX results were estimated. RESULTS: Among 191 patients, 46 had osteoporosis (24.1%) and 119 had low BMD (62.3%). For predicting osteoporosis, SCORE showed the highest sensitivity (96%), whereas OSIRIS (87%) and ORAI (82%) showed the highest specificities. OSIRIS also had the greatest positive PV (92%). The specific indices had low sensitivity and low specificity (Amsterdam, 50% and 79%, respectively; modified Amsterdam, 56% and 70%). All the indices had a low but significant correlation with FRAX. CONCLUSION: These findings support the use of some generic indices to identify patients with RA who should undergo DEXA testing. Currently available specific indices did not perform satisfactorily. New specific risk indices for osteoporosis in RA should be developed to increase sensitivity and specificity for predicting osteoporosis.

OBJECTIVE: To evaluate the association between circulating leptin and bone mineral density (BMD) in patients with rheumatoid arthritis (RA). METHODS: One-hundred thirty postmenopausal women with RA were assessed for body mass index (BMI), disease characteristics, history of drug use, rheumatoid factor, and erythrocyte sedimentation rate (ESR). BMD (g/cm2) was determined in the hip and spine by DEXA. Serum leptin concentrations were measured by ELISA. Spearman’s correlation coefficients (rho) were determined between BMD and leptin and other variables. A multiple regression analysis was used to adjust for confounders. RESULTS: Patients’ serum leptin levels varied widely (range 2–128 ng/ml). Thirty-three patients (25%) had osteoporosis. Higher levels of leptin correlated significantly with BMD in the lumbar spine (rho = 0.17, p = 0.04) and total hip (rho = 0.21, p = 0.01). The variables that were negatively correlated with BMD were age, duration of menopause, and ESR. After adjustment for confounders, leptin was no longer associated with BMD. In the multivariate model, factors that remained associated with BMD in the total hip were age (p = 0.021) and BMI (p = 0.003); and the factors that remained associated with BMD in the lumbar spine were BMI (p = 0.03) and ESR (p = 0.01). CONCLUSION: No relevant association was found between circulating leptin levels and BMD in patients with RA in this cross-sectional study. Followup studies are needed to evaluate whether abnormal leptin levels confer a risk for fractures due to osteoporosis.

Objective. The authors developed a Markov decision model to evaluate the health implications of testing for mutations in the BRCA1 and BRCA2 breast-ovarian cancer susceptibility genes. Prophylactic measures considered included various combinations of immediate and delayed bilateral mastectomy and oophorectomy or taking no action. Methods. The model incorporated the likelihood of developing breast and/or ovarian cancer, survival, and quality of life. Parameter values were taken from public data bases, the published literature, and a survey of cancer experts. Outcomes considered were additional life expectancy and quality-adjusted life years (QALYs). Results are reported for 30-year-old cancer-free women at various levels of hereditary risk. Results and conclusions. The vast majority of women will not benefit from testing because their pre-test risks are low and surgical prophylaxis is undesirable. However, women who have family histories of early breast and/or ovarian cancer may gain up to 2 QALYs by allowing genetic testing to inform their decisions. Key words: BRCA1; BRCA2; ge netic testing; breast cancer; ovarian cancer; decision analysis. (Med Decis Making 1998;18:365-375)