肌少症与跌倒对类风湿关节炎患者椎体骨质疏松性骨折的交互作用。
Interactive effect of sarcopenia and falls on vertebral osteoporotic fracture in patients with rheumatoid arthritis.
机构信息
Department of Rheumatology & Immunology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China.
出版信息
Arch Osteoporos. 2021 Oct 3;16(1):145. doi: 10.1007/s11657-021-01017-1.
UNLABELLED
Patients with rheumatoid arthritis (RA) had higher incidences of sarcopenia, falls, osteoporosis, and vertebral osteoporotic fractures (VOPF). Sarcopenia was associated with longer disease duration, higher disease activity, and more severe RA. The interactive effect of sarcopenia and falls was associated with a higher risk of VOPF in patients with RA.
PURPOSE
Whether sarcopenia and falls are a risk factor for vertebral fracture in RA patients has not been demonstrated. This study aimed to explore the incidence of vertebral osteoporotic fracture (VOPF) and its relationship with sarcopenia and falls in RA patients.
METHODS
A total of 474 RA patients and 156 controls were enrolled in this study. Anteroposterior and lateral X-ray examinations of the vertebral column (T4-L4) were used for the semiquantitative assessment of VOPF. Bone mineral density was measured by dual-energy X-ray absorptiometry. Skeletal muscle mass was measured by direct segmental multifrequency bioelectrical impedance analysis (DSM-BIA method).
RESULTS
RA patients had an increased risk of sarcopenia (62.4% vs 9.0%, x = 47.478, P < 0.001), falls (30.2% vs 3.2%), osteoporosis (OP) (33.5% vs 12.8%, x = 134.276, P < 0.001), and VOPF (20.3% vs 3.8%, x = 47.478, P < 0.001) than controls. Patients with sarcopenia were more likely to have VOPF than RA without sarcopenia (24.0% vs 14.0%, x = 6.802, P = 0.009). RA with sarcopenia and prior falls had the highest incidences of VOPF (36.7%). Older age (OR = 1.056, P < 0.001, 95% CI 1.030-1.083), falls (OR = 2.043, P = 0.003, 95% CI 1.238-3.371), OP (OR = 1.819, P = 0.034, 95% CI 1.046-3.163), and usage of glucocorticoids (GCs) (OR = 1.862, P = 0.022, 95% CI 1.093-3.172) were risk factors for VOPF in RA patients, while a higher skeletal muscle index (SMI) was a protective factor (OR = 0.754, P = 0.038, 95% CI 0.578-0.984) for VOPF in RA patients.
CONCLUSIONS
The interactive effect of sarcopenia and falls is associated with a higher risk of VOPF in patients with RA.
背景
类风湿关节炎（RA）患者的肌少症、跌倒、骨质疏松症和椎体骨质疏松性骨折（VOPF）发生率较高。肌少症与疾病持续时间较长、疾病活动度较高和 RA 更严重有关。肌少症和跌倒的交互作用与 RA 患者 VOPF 风险增加有关。
目的
肌少症和跌倒是否是 RA 患者椎体骨折的危险因素尚未得到证实。本研究旨在探讨 RA 患者 VOPF 的发生率及其与肌少症和跌倒的关系。
方法
本研究纳入了 474 例 RA 患者和 156 例对照者。采用脊柱（T4-L4）前后位和侧位 X 线检查对 VOPF 进行半定量评估。采用双能 X 线吸收法测量骨密度。采用直接节段多频生物电阻抗分析（DSM-BIA 法）测量骨骼肌质量。
结果
与对照组相比，RA 患者肌少症（62.4%比 9.0%，x2=47.478，P<0.001）、跌倒（30.2%比 3.2%，x2=34.276，P<0.001）、骨质疏松症（33.5%比 12.8%，x2=134.276，P<0.001）和 VOPF（20.3%比 3.8%，x2=47.478，P<0.001）的发生率更高。与无肌少症的 RA 患者相比，有肌少症的患者更易发生 VOPF（24.0%比 14.0%，x2=6.802，P=0.009）。有肌少症且有既往跌倒史的 RA 患者 VOPF 发生率最高（36.7%）。年龄较大（OR=1.056，P<0.001，95%CI 1.030-1.083）、跌倒（OR=2.043，P=0.003，95%CI 1.238-3.371）、骨质疏松症（OR=1.819，P=0.034，95%CI 1.046-3.163）和使用糖皮质激素（GCs）（OR=1.862，P=0.022，95%CI 1.093-3.172）是 RA 患者发生 VOPF 的危险因素，而较高的骨骼肌指数（SMI）是 RA 患者发生 VOPF 的保护因素（OR=0.754，P=0.038，95%CI 0.578-0.984）。
结论
肌少症和跌倒的交互作用与 RA 患者 VOPF 风险增加有关。
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