Abstract Objectives Data on bone microarchitecture in premenopausal women with rheumatoid arthritis (RA) are scarce and have not been evaluated using histomorphometry. We assessed bone fragility in premenopausal RA women through static and dynamic histomorphometric parameters, compared to age- and sex-matched controls. Methods Eighty patients were screened, and iliac crest biopsies were performed in those with fragility fractures or low BMD (Z-score ≤ −2.0). All analyses focus exclusively on the 12 women who underwent bone biopsy. Results Among these 12 premenopausal women with longstanding RA, mean age was 41.8 ± 6.6 yr and disease duration was 10.8 ± 5.8 yr. Bone volume (BV/TV) was numerically lower in RA patients compared with controls (p = .064). Thus, a reduction in bone volume cannot be excluded, given the limited statistical power. RA patients demonstrated reduced trabecular thickness, increased cortical porosity, and higher osteoclastic surface. Dynamic evaluation showed markedly lower mineralizing surface (MS/BS) and greater variability in mineralization lag time (Mlt). However, Mlt values remained within the physiological range and do not meet histological criteria for osteomalacia. Four patients (33%) showed absent tetracycline labeling. Osteoid indices correlated positively with disease activity, and MS/BS correlated inversely with glucocorticoid dose. Conclusion In this selected group of premenopausal women with longstanding RA and osteoporosis by clinical criteria, bone fragility appears to result from a combination of trabecular thinning, cortical porosity, and disturbances in mineralization kinetics rather than from classic histomorphometric osteoporosis or osteomalacia.
Perez et al. (2026) studied this question.