S05:6 | Prevalence of osteoporosis and bone mineral metabolism disorders in an Italian cohort of patients with microcrystalline arthritis: results from the PREMIA observational study of the Italian Society of Rheumatology

Silvia Grignaschi¹, Sonia Farah², Silvia Balduzzi¹, Bernd Raffeiner³, Carlomaurizio Montecucco⁴, Fausto Salaffi², Enrico Selvi⁵, Annamaria Iagnocco⁶, Fabiola Atzeni⁷, Serena Guiducci⁸, Rosario Foti⁹, Maria Manara¹⁰, Marcello Govoni¹¹, Carlo Selmi¹², Francesca Oliviero¹³, Roberta Ramonda¹³ | ¹ASST Pavia; ²Ospedale Carlo Urbani Jesi Italy; ³Azienda Sanitaria dell'Alto Adige, Bolzano; ⁴IRCCS Fondazione Policlinico San Matte, Pavia; ⁵AOU Senese, Siena; ⁶Ospedale MAuriziano, Torino; ⁷Università di Messina; ⁸AOU Careggi, Firenze; ⁹AOU Policlinico G. Rodolico, Catania; ¹⁰ASST Gaetano Pini-CTO Milano; ¹¹AUSL Ferrara; ¹²Humanitas San Pio X, Milano; ¹³AOU Padova, Italy

Background. Rheumatologic diseases are frequently associated with osteoporosis (OP) and bone mineral metabolism disorders. Crystal-induced arthropathies, in particular, may involve alterations in calcium, phosphate and parathyroid hormone (PTH) that act as both pathogenic and predisposing factors. This study aimed to evaluate the prevalence of OP and related metabolic disturbances in patients enrolled in the PREMIA study, promoted by the Italian Society of Rheumatology’s Microcrystalline Arthritis Study Group (AMC).

Methods. A total of 1,003 patients from Italian rheumatology centers participating in the PREMIA project were included. Each patient underwent a specialist rheumatologic evaluation, clinical data collection, and basic laboratory testing. Suspected OP or bone metabolism disorder was defined by at least one of the following: (a) history of fragility fracture, (b) pharmacologic treatment for OP, or (c) abnormal serum levels of calcium, phosphate, alkaline phosphatase, or PTH. Patients were stratified according to rheumatologic diagnosis and comorbidities.

Results. Overall, 244 patients (24.3%; 95% CI: 21.7%–27.1%) met criteria for OP or bone metabolism disorder, with a predominance of women (62.3%) and a mean age of 69.4 years. Altered serum calcium was detected in 21.5% of cases, and 10.3% were receiving OP treatment (Fig. 1). Among rheumatologic comorbidities, rheumatoid arthritis (42.4%), osteoarthritis (36.7%), connective tissue diseases (34.5%), and systemic vasculitis (33.3%) showed the highest association with OP (Tab. 1). Notably, 32.6% of patients with chronic gout presented evidence of altered bone mineral metabolism.

Discussion. Approximately one in four patients with microcrystalline arthritis exhibits osteoporosis or bone metabolism disturbances, with prevalence increasing to one in three among those with rheumatoid arthritis, osteoarthritis, or connective tissue disease. These findings indicate that bone fragility extends beyond traditional risk groups to include chronic crystal arthropathies. The association with age and post-menopausal status was confirmed, but the occurrence in younger patients with systemic diseases underscores the importance of bone health assessment across all age groups. Integrating clinical and biochemical parameters proved effective for early identification of at-risk patients, reflecting real-world rheumatology practice where osteoporosis risk is often underrecognized.