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immuno-mediated inflammatory diseases characterized by abnormal expressions of keratinocytes&#44; as well as proliferation and neovascularization of the synovial&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Although patients with PsA seem to have local and systemic osteoporosis&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> little is known concerning the actual degree of bone loss&#46; Nowadays&#44; certain issues&#44; specially related to the magnitude of the problem in practice&#44; remain to be clarified&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">We report a cross-sectional study that used dual X-ray absorptiometry &#40;DXA&#41; to evaluate BMD at the lumbar spine and the hip and the frequency of osteoporosis and clinical fractures in 155 Spanish patients with peripheral PsA&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Patients and methods</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Study setting</span><p id="par0030" class="elsevierStylePara elsevierViewall">The study was performed at the Rheumatology Department of the Hospital Universitari de Bellvitge&#46; Our department has developed a standardized protocol to collect information on PsA patients&#46; Collected data include medical history&#44; physical&#44; laboratory and imaging study findings&#44; and management&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients</span><p id="par0035" class="elsevierStylePara elsevierViewall">We considered for the current study all PsA patients who had been attended within one-year period &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>202&#41; in our outpatient clinics&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">We excluded patients who met any of the following criteria&#58; &#40;a&#41; disease duration &#60;<span class="elsevierStyleHsp" style=""></span>1 year &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41;&#44; &#40;b&#41; evidence of ankylosing spondylitis &#40;psoriatic spondyloarthropathy&#41; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>18&#41; and &#40;c&#41; current clinical remission&#44; defined as the absence of articular signs and symptoms for the last 6 months &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>14&#41;&#46; Patients with axial involvement were excluded in order to avoid interferences in BMD measurement due to syndesmophytes&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">One hundred and fifty-eight patients were invited to participate in the study&#59; 155 gave their informed consent&#46; All patients fulfilled the diagnostic criteria for PsA defined by the Classification of Psoriatic Arthritis &#40;CASPAR&#41; study&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> None had received hormone replacement therapy or any drug for osteoporosis treatment other than calcium or vitamin D&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Outcome measure</span><p id="par0050" class="elsevierStylePara elsevierViewall">A full medical history was obtained and a complete physical examination was undergone&#46; The following data were recorded&#58; &#40;1&#41; gender&#44; &#40;2&#41; menopausal status&#44; &#40;3&#41; age&#44; &#40;4&#41; body mass index &#40;BMI&#41;&#44; &#40;5&#41; duration of PsA&#44; &#40;6&#41; type of PsA&#58; oligoarticular &#40;one to four swollen joints&#41; or polyarticular &#40;five or more swollen joints&#41;&#44; &#40;7&#41; cutaneous involvement&#44; &#40;8&#41; onychopathy&#44; &#40;9&#41; uveitis&#44; &#40;10&#41; glucocorticoid treatment&#44; &#40;11&#41; disease modifying anti-rheumatic drugs &#40;DMARD&#41; use&#44; &#40;12&#41; biological therapy use&#44; &#40;13&#41; erythrocyte sedimentation rate evaluated by the Westergren method &#40;the value of the last routine determination was considered&#41;&#44; &#40;14&#41; functional status&#59; it was measured by the modified Health Assessment Questionnaire &#40;mHAQ&#41;&#44; and &#40;15&#41; personal history of low impact fractures&#46; All patients were referred to the Bone Densitometry Unit of our department&#46; BMD &#40;g&#47;cm<span class="elsevierStyleSup">2</span>&#41; was measured at the lumbar spine &#40;L2&#8211;L4&#41; and the hip by DXA &#40;Hologic QDR 4500&#44; Hologic Inc&#46;&#44; Waltham&#44; MA&#41;&#46; The T-score &#40;comparison with normal subjects of the same sex with peak bone mass&#41; and the Z-score &#40;comparison with age and sex matched normal controls&#41; were established by comparison with data from the study of BMD at the lumbar spine and femoral neck in a Spanish population performed by the Multicentre Research Project on Osteoporosis &#40;MRPO&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Osteopenia &#40;T-score between &#8722;1&#46;0 and &#8722;2&#46;5&#41; and osteoporosis &#40;T-score below &#8722;2&#46;5&#41; were defined according to the criteria of the World Health Organization&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Additionally&#44; according to the International Society of Clinical Densitometry&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> in premenopausal women and in male younger than 50 years&#44; we calculated the percentage of patients that presented a BMD below the expected range for age &#40;Z-score of &#8722;2 or lower&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In 2 patients with bilateral hip prosthesis&#44; only lumbar BMD was available&#46; In other 2 patients&#44; lumbar BMD was not determined because of the antecedent of instrumented surgery of the spine&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Statistical analysis</span><p id="par0065" class="elsevierStylePara elsevierViewall">The study variables were tabulated as means and standard deviations &#40;SD&#41;&#44; or proportions as applicable&#46; Confidence interval &#40;CI&#41; was used to assess the difference between the mean Z-score at each site and the general population&#46; Differences between groups of patients were assessed by ANOVA and chi squared tests&#46; Statistical significance was set at <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0070" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the demographic and clinical characteristics of the patients included in the study&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the densitometric status of the patients included in the study&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the frequency of osteoporosis according to the WHO criteria in the whole series and in each defined subgroup&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">In premenopausal women&#44; the frequency of patients&#44; that presented&#44; in at least one of the evaluated sites&#44; a BMD below the expected range for age was 15&#37; &#40;4&#47;26&#41;&#59; in males younger than 50&#44; it was 19&#37; &#40;4&#47;21&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Fifty-nine &#40;38&#37;&#41; patients had a normal BMD &#40;T-score<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>&#8722;1 SD&#41; both in the lumbar spine and hip &#40;femoral neck and total hip&#41;&#46; Patients with a normal BMD were younger &#40;52&#46;05<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;92 vs 57&#46;59<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;07 years&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; had a shorter duration of PsA &#40;11&#46;00<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;39 vs 15&#46;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;11 years&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#44; had a higher BMI &#40;28&#46;69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;19 vs 26&#46;28<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;43&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41; and presented a better HAQ &#40;0&#46;51<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;46 vs 0&#46;78<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;67&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">No differences were found in BMD between patients with oligoarticular and polyarticular involvement&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Thirteen percent of the patients &#40;19&#47;155&#41; had had a clinical low-trauma fracture&#46; This complication accounted specially in postmenopausal women &#40;16 cases&#44; 84&#37;&#41;&#46; The most frequent localization was the forearm &#40;10 cases&#41;&#59; one case of vertebral fracture and another of hip fracture were found&#46; Clinical and demographic data were similar in patients with and without fracture&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">We have analyzed the BMD status&#44; the frequency of osteoporosis and the clinical fractures in a large group of Spanish patients with PsA&#46; We found no differences in BMD status between the patients and the Spanish general population&#46; In the overall series&#44; frequency of osteoporosis was 16&#37; and frequency of clinical fractures&#44; 13&#37;&#46; As expected&#44; frequency of osteoporosis was clearly higher in postmenopausal women &#40;28&#37;&#41; than in men &#40;9&#37;&#41; or premenopausal women &#40;4&#37;&#41;&#59; in this way&#44; the majority of clinical fractures accounted in postmenopausal women&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">To date&#44; few studies are available in which BMD has been evaluated&#44; using DXA&#44; in patients with psoriasis and&#44; more surprisingly&#44; in patients with PsA&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In a recent study&#44; Dreiher et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> analyzed the prevalence of osteoporosis in a large database of patients with psoriasis &#40;7936 subjects&#41;&#46; No difference was found among women&#44; while among men&#44; patients with psoriasis showed a higher prevalence than controls &#40;14&#46;835 subjects&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Unfortunately&#44; the studies that identify patients with arthritis deal with smaller sample sizes&#46; In the 1990s&#44; our group<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> measured BMD in 52 patients with PsA &#40;14 premenopausal women&#44; 19 postmenopausal women and 19 men&#41;&#59; the only difference in densitometric data was at the femoral neck in the postmenopausal subgroup&#44; with a BMD significantly lower than in controls&#46; More recently&#44; Borman et al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> evaluated&#44; by DXA&#44; BMD at lumbar spine and total hip in a series of 47 patients &#40;24 premenopausal women&#44; 23 men&#41; with psoriasis &#40;18 with PsA&#41;&#46; There was no significant difference between the BMD levels of psoriatic patients with and without arthropathy&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Only two studies<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a> on the prevalence of osteoporosis in patients with PsA include a substantial number of subjects&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Frediani et al&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> studied 186 patients with peripheral PsA and 100 healthy subjects&#44; equally distributed in 3 groups&#58; women of child-bearing age&#44; women in menopause and men&#46; No patient had received previously steroid treatment&#46; BMD was significantly lower in the arthritic than in the healthy subjects regardless of gender&#44; menopausal status&#44; or age&#44; as expressed in g&#47;cm<span class="elsevierStyleSup">2</span> or by T and Z scores&#46; Among PsA patients&#44; osteoporosis in at least one skeletal region was observed in 11&#37; of premenopausal women&#44; 47&#37; of postmenopausal women and 29&#37; of men&#46; In the whole series&#44; age&#44; BMI and HAQ were significant predictors of bone mass&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Hofbauer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> studied 116 patients with peripheral PsA&#44; 57 women &#40;mean age 56<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11<span class="elsevierStyleHsp" style=""></span>yrs&#44; 61&#37; postmenopausal&#41; and 59 men &#40;mean age 49<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13<span class="elsevierStyleHsp" style=""></span>yrs&#41;&#46; None of the patients had received glucocorticoids or DMARDs for the last 12 months and no patient had a history of long-term &#40;&#62;6 months&#41; glucocorticoid therapy&#46; Osteoporosis was detected in only one woman &#40;1&#46;75&#37;&#41;&#44; but in six men &#40;10&#46;2&#37;&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">As <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows&#44; the frequency of osteoporosis found in the present study is situated in an intermediate position with respect to the obtained by Frediani et al&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> and Hofbauer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46; The discrepancies between the results of these three studies probably may be ascribable to differences in the demographical&#44; clinical and therapeutical variables with capacity to influence over bone mass&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">In any case&#44; it seems that it is possible to support that the intensity of bone loss in PsA is lower than the observed in RA&#44; the major inflammatory arthropathy&#46; PsA differs from RA in several ways&#44; including more intermittent disease activity&#44; milder inflammation&#44; milder functional impairment&#44; and less frequent use of glucocorticoids&#59; these differences may result in a better bone mass preservation in PsA as compared to RA&#46; Additionally&#44; the difference in bone involvement between the two diseases could be largely determined by a different balance and expression of the factors controlling the coupling cycle of bone remodelling<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">There is a relevant absence of data on fracture in patients with PsA&#46; Information is available only in one recent study&#44; published by Pedreira et al&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Data refer to a sample of 45 postmenopausal women with PsA &#40;mean age&#58; 60&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;7<span class="elsevierStyleHsp" style=""></span>yrs&#41;&#44; 52 patients with psoriasis &#40;mean age&#58; 61&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;1<span class="elsevierStyleHsp" style=""></span>yrs&#41; and 98 healthy controls&#46; The prevalence of fragility fractures among patients with PsA &#40;33&#37;&#41; was significantly greater than that observed in patients with psoriasis &#40;28&#46;8&#37;&#41;&#46; Both prevalence rates are reported as significantly greater compared to controls&#44; but prevalence of fractures in controls is not provided&#46; Interestingly&#44; BMD data of lumbar spine and proximal femur are not significantly different in the 3 groups&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">The frequency of fractures observed in the present study &#40;13&#37;&#41; was clearly minor&#46; Probably&#44; this fact is consequence that&#44; unlike Pedreira et al&#46;&#44; we have not performed a thoracic and lumbar spine-X-ray analysis&#44; in search of radiological vertebral fractures&#44; a circumstance that constitutes a clear limitation of our study&#46; However&#44; every day clinical practice seems to suggest that osteoporotic fracture is not a prominent feature of the course PsA and the obtained data support this assumption&#46; In fact&#44; when we previously analyzed 669 patients with osteoporotic vertebral fracture diagnosed in our department over a 10-year period&#44; only one case of PsA was observed&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Our data&#44; and the literature review&#44; suggest that the magnitude of the problem of osteoporosis in PsA is mild&#46; Nevertheless&#44; it seems necessary to design large longitudinal prospective studies in order to characterize definitively the bone loss accounting in PsA patients&#46; In addition&#44; we need fracture studies than can define the risk of such an important complication&#44; which may depend largely on factors other than BMD alone&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Opinion</span><p id="par0165" class="elsevierStylePara elsevierViewall">Osteoporosis does not appear to be a significant problem in patients with psoriatic arthritis&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Ethical responsibilities</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Protection of people and animals</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors declare that this research experiments have not been done in humans or animals&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Confidentiality of data</span><p id="par0175" class="elsevierStylePara elsevierViewall">Confidentiality of data&#46; The authors declare that they have followed the protocols of their workplace on the publication of data from patients and that all patients included in the study have received sufficient information and have given their informed consent to participate in the study&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflict of interest</span><p id="par0185" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interests&#46;</p></span></span>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To assess the bone mineral density &#40;BMD&#41; and the frequency of osteoporosis and clinical fractures in a large group of Spanish patients with psoriatic arthritis &#40;PsA&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">BMD was determined by DXA in all the patients who were willing to participate and had peripheral PsA regularly evaluated in a tertiary university hospital&#46; All patients underwent a physical examination and general laboratory analysis&#46; We gathered demographic and clinical variables related with BMD and risk of fractures&#46; We also recorded the history of clinical low impact fractures&#46; The population of reference to calculate T-score and Z-score came from a Spanish database&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">One hundred and fifty-five patients were included &#40;64 postmenopausal women&#44; 26 premenopausal women and 65 men&#41;&#46; The clinical forms of PsA were&#58; 46&#37; oligoarticular and 54&#37; polyarticular&#46; Mean disease duration was 13&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;4 years and mean ESR was 21&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;9<span class="elsevierStyleHsp" style=""></span>mm&#47;h&#59; 66&#37; of patients had received glucocorticoid treatment&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">We found no differences in BMD status between the patients and the Spanish general population&#44; neither in the whole series nor in each defined subgroup&#46; Frequency of osteoporosis was 16&#37;&#59; it was higher in postmenopausal women &#40;28&#37;&#41; than in men &#40;9&#37;&#41; or premenopausal women &#40;4&#37;&#41;&#46; Frequency of clinical fractures was 13&#37;&#59; it accounted specially in postmenopausal women&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The magnitude of the problem of osteoporosis in PsA seems to be mild&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Analizar el estado de la densidad mineral &#243;sea &#40;DMO&#41; as&#237; como la frecuencia de osteoporosis y de fracturas cl&#237;nicas en una serie de pacientes con artritis psori&#225;sica &#40;APs&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y M&#233;todo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se determin&#243; la DMO&#44; mediante DXA&#44; en todos los pacientes con APs perif&#233;rica&#44; evaluados de forma peri&#243;dica en un hospital universitario&#44; que aceptaron participar en el estudio&#46; Se les practic&#243; una exploraci&#243;n f&#237;sica y un estudio anal&#237;tico y se recab&#243; informaci&#243;n acerca de variables cl&#237;nicas relacionadas con la DMO y con el riesgo de fractura&#46; Asimismo&#44; se analiz&#243; si exist&#237;a el antecedente de haber presentado una fractura de bajo impacto&#46; El c&#225;lculo del T-score y del Z-score se realiz&#243; a partir de una base de datos de poblaci&#243;n espa&#241;ola&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 155 pacientes &#40;64 mujeres posmenop&#225;usicas&#44; 26 mujeres premenop&#225;usicas y 65 varones&#41;&#46; En el 46&#37; de los casos la APS adopt&#243; un patr&#243;n oligoarticular y en el 54&#37; poliarticular&#46; La duraci&#243;n media de la enfermedad fue 13&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;4 a&#241;os&#44; el valor medio de la VSG fue de 21&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;9<span class="elsevierStyleHsp" style=""></span>mm&#47;h&#59; el 66&#37; de los pacientes hab&#237;an recibido tratamiento con glucocorticoides&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">No se observaron diferencias entre la DMO de los pacientes y la de la poblaci&#243;n general&#44; ni en la globalidad de la serie&#44; ni en ninguno de los tres grupos&#46; La frecuencia global de osteoporosis se situ&#243; en el 16&#37;&#59; fue m&#225;s alta en las mujeres posmenop&#225;usicas &#40;28&#37;&#41; que en los varones &#40;9&#37;&#41; y que en las mujeres premenop&#225;usicas &#40;4&#37;&#41;&#46; La frecuencia de fracturas cl&#237;nicas fue del 13&#37;&#59; acontecieron fundamentalmente en las mujeres posmenop&#225;usicas&#46;</p>"
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">PsA&#58; psoriatic arthritis&#59; DMARD&#58; disease modifying anti-rheumatic drugs&#59; ESR&#58; erythrocyte sedimentation rate&#59; HAQ&#58; Health Assessment Questionnaire&#46;</p>"
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            0 => array:2 [
              "tabla" => array:1 [
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">27&#46;20<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;86&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">28&#46;25<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;02&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">26&#46;88<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;92&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">32 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">24 &#40;37&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t">32 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">41 &#40;63&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t">148 &#40;96&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">25 &#40;96&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62 &#40;97&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">61 &#40;94&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t">91 &#40;59&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">13 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;55&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43 &#40;66&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">2 &#40;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8226; Ever users&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">102 &#40;66&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;70&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;0&#46;97<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;24&#40;&#8722;1&#46;2 to &#8722;0&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Z-score &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;20<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;04&#40;&#8722;0&#46;1 to 0&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;10<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;15&#40;&#8722;0&#46;2 to 0&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;56<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;20&#40;&#8722;0&#46;3 to 0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Premenopausal women &#40;n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">26&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>BMD&#44; g&#47;cm<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;033<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;807<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;103&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;906<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;134&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>T-score &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;02<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;03&#40;&#8722;0&#46;44 to 0&#46;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;17<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;03&#40;&#8722;0&#46;5 to 0&#46;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;60<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;15&#40;&#8722;1&#46;06 to &#8722;0&#46;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Z-score &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;07<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;01&#40;&#8722;0&#46;33 to 0&#46;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;10<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;01&#40;&#8722;0&#46;51 to 0&#46;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;40<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;19&#40;&#8722;0&#46;88 to 0&#46;08&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Postmenopausal women &#40;n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">64&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>BMD&#44; g&#47;cm<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;909<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;138&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;717<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;128&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;840<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;149&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>T-score &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;33&#40;&#8722;1&#46;56 to&#8211;0&#46;89&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;04<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;24&#40;&#8722;1&#46;36 to 0&#46;73&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Z-score &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;26<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;06&#40;&#8722;0&#46;01 to 0&#46;53&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;18<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;20&#40;&#8722;0&#46;13 to 0&#46;48&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Male &#40;n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">65&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>BMD&#44; g&#47;cm<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;797<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;122&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;957<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;138&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>T-score &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;31<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;96&#40;&#8722;0&#46;6 to &#8722;0&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;83<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;96&#40;&#8722;1&#46;1 to &#8722;0&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;0&#46;86<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;06&#40;&#8722;1&#46;1 to &#8722;0&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Z-score &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;03<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;86&#40;&#8722;0&#46;2 to 0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;0&#46;17<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;05&#40;&#8722;0&#46;4 to 0&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;0&#46;09<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;12&#40;&#8722;0&#46;4 to 0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Any site&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Overall series&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>155&#41; &#40;95&#37;CI&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#37;&#40;3&#37;&#8211;11&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#37;&#40;7&#37;&#8211;17&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#37;&#40;11&#37;&#8211;23&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Premenopausal women&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41; &#40;95&#37;CI&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#37;&#40;1&#37;&#8211;19&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">17&#37;&#40;10&#37;&#8211;28&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#37;&#40;9&#37;&#8211;26&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#37;&#40;19&#37;&#8211;40&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Men&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>65&#41; &#40;95&#37;CI&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#37;&#40;0&#37;&#8211;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#37;&#40;4&#37;&#8211;19&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#37;&#40;4&#37;&#8211;19&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t" style="border-bottom: 2px solid black">Frediani et al&#46; <a class="elsevierStyleCrossRef" href="#bib0085">&#40;17&#41;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">186&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">27&#46;20<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;86&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">ESR&#44; mm&#47;h</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Femoral T-score</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;0&#46;39<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;17&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;0&#46;80<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;13&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Femoral Z-score</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;08<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;07&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;0&#46;01<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;11&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8226; Premenopausal women&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8226; Postmenopausal women&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Comparison between the reported data of Frediani et al&#46; <a class="elsevierStyleCrossRef" href="#bib0085">&#40;17&#41;</a>&#44; Hofbauer et al&#46; <a class="elsevierStyleCrossRef" href="#bib0090">&#40;18&#41;</a> and the present study&#46;</p>"
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                      "titulo" => "Bone mineral density and frequency of osteoporosis in female patients with rheumatoid arthritis&#58; results from 394 patients in the Oslo County Rheumatoid Arthritis register"
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