Elevated inflammatory markers are associated with impaired bone health in patients with adult-onset Still’s disease: A cross-sectional study

Adult-onset Still’s disease (AOSD) is a chronic systemic inflammatory disorder with sustained elevation of pro-inflammatory cytokines and frequent glucocorticoid use. Real-world data on bone health in AOSD remain scarce. This study aimed to evaluate bone health parameters and their associations with inflammatory markers in patients with AOSD. This cross-sectional study included 54 patients with AOSD who underwent dual-energy x-ray absorptiometry (DXA) at a tertiary referral center. Bone mineral density (BMD) at the lumbar spine, femoral neck, and total hip, and trabecular bone score (TBS) were assessed. Associations between C-reactive protein (CRP), ferritin, cumulative glucocorticoid dose, and bone parameters were analyzed using Spearman correlation, partial correlation adjusted for age, sex, and body mass index (BMI), and multivariable logistic regression. The mean age was 58.2 ± 12.0 years (79.6% female). Osteoporosis and osteopenia were present in 40.7% and 38.9%, respectively. TBS assessment (n = 52) revealed that 38 patients (73.1%) had normal microarchitecture (TBS > 1.350) and 14 (26.9%) had partially degraded microarchitecture (TBS 1.200–1.350). CRP showed a significant negative correlation with TBS ( r  = −0.445, P = .001), which remained significant after Bonferroni correction (adjusted P = .019) and after partial correlation adjusting for age, sex, and BMI ( r  = −0.336, P = .015). In multivariable logistic regression adjusted for age, sex, and BMI, CRP was independently associated with osteoporosis (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.01–1.27, P = .039). In patients aged ≥ 50 years, log-transformed ferritin was independently associated with osteoporosis (OR 4.34, 95% CI 1.43–13.13, P = .009). Cumulative glucocorticoid dose was not significantly associated with bone parameters. These real-world data demonstrate a high burden of impaired bone health in patients with AOSD. CRP was independently associated with TBS and osteoporosis after adjustment for age, sex, and BMI, and ferritin was associated with osteoporosis in patients aged ≥50 years. These findings support the need for routine bone health screening in AOSD.