We express our sincere gratitude to Dr. Yoshii for showing keen interest in our manuscript [
]. We strongly concur with his comment that achieving sustained clinical remission, as measured by the Simplified Disease Activity Index (SDAI), alongside monitoring serum albumin levels, is crucial in preventing osteoporosis and bone fragility fractures (BFF) in patients with rheumatoid arthritis (RA) [
- Nagayama Y.
- Ebina K.
- Tsuboi H.
- Hirao M.
- Hashimoto J.
- Yoshikawa H.
- Okada S.
- Nakata K.
Low serum albumin concentration is associated with increased risk of osteoporosis in postmenopausal patients with rheumatoid arthritis.
J Orthop Sci. 2022 Nov; 27: 1283-1290
]. This is because elevated disease activity, which is not only associated with hypoalbuminemia [
- Yoshii I.
- Chijiwa T.
- Sawada N.
Rheumatoid arthritis in tight disease control is no longer risk of bone mineral density loss.
Osteoporos Sarcopenia. 2020 Jun; 6: 75-81
] but also to higher levels of pro-inflammatory cytokines such as tumor necrosis factor-alpha and interleukin-6, can trigger osteoclastogenesis while impeding osteogenesis [
- Wilkinson P.
- Jeremy R.
- Brooks F.P.
- Hollander J.L.
The mechanism of hypoalbuminemia in rheumatoid arthritis.
Ann Intern Med. 1965 Jul; 63: 109-114
- Tanaka Y.
Clinical immunity in bone and joints.
J Bone Miner Metabol. 2019 Jan; 37: 2-8
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- Low serum albumin concentration is associated with increased risk of osteoporosis in postmenopausal patients with rheumatoid arthritis.J Orthop Sci. 2022 Nov; 27: 1283-1290
- Rheumatoid arthritis in tight disease control is no longer risk of bone mineral density loss.Osteoporos Sarcopenia. 2020 Jun; 6: 75-81
- The mechanism of hypoalbuminemia in rheumatoid arthritis.Ann Intern Med. 1965 Jul; 63: 109-114
- Clinical immunity in bone and joints.J Bone Miner Metabol. 2019 Jan; 37: 2-8
Published online: March 10, 2023
Accepted: February 28, 2023
Received: February 27, 2023
Publication stageIn Press Corrected Proof
© 2023 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.