Department of Rheumatology & Immunology, the First Affiliated Hospital of Anhui Medical University, No. 218, Ji-xi Road, Hefei, 230022, Anhui, China.
Clin Rheumatol. 2022 Jul;41(7):1979-1987. doi: 10.1007/s10067-022-06125-y. Epub 2022 Mar 6.
To explore the synergistic effect of vitamin D deficiency and sarcopenia on vertebral osteoporostic fracture (VF) in patients with rheumatoid arthritis (RA).
A total of 188 patients with RA and 158 control subjects were enrolled. Bone mineral density (BMD) at the total hip, neck of femur, lumbar vertebra 1-4, and skeletal muscle mass was measured by dual energy X-ray absorptiometry (DXA) and biological electrical impedance, respectively. Serum 25(OH)D was tested by electrochemiluminescence. The prevalence of VF and osteoporosis (OP) were compared between RA and controls. The synergism of sarcopenia and vitamin D deficiency on VF in patients with RA was tested by χ test and logistic regression.
The prevalence of OP at all measured sites and VF in RA patients were all higher than those in controls (P < 0.0001). The incidence of VF in RA either with sarcopenia or with vitamin D deficiency was higher than for those without sarcopenia or without vitamin D deficiency (χ = 5.069, P = 0.027, χ = 8.822, P = 0.001). Age, disease duration, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), DAS28, health assessment questionnaire (HAQ), Sharp score, and body mass index (BMI) were significantly different between RA with sarcopenia or not (P < 0.05). Logistic regression analysis found that age (OR = 1.095, 95%, CI: 1.044-1.150, P < 0.0001) was a significant risk factor for VF in patients with RA, while high skeletal muscle mass (SMI) (OR = 0.513, 95% CI: 0.327-0.804, P = 0.004) was a protective factor for VF in RA patients.
VF, sarcopenia, and vitamin D deficiency are common in patients with RA. Sarcopenia and vitamin D deficiency may be risk factors for the incidence of VF in RA patients.
• RA patients had a higher incidence of OP and VF, also a high prevalence of sarcopenia and vitamin D deficiency. • Vitamin D deficiency and sarcopenia may might have a synergistic effect on VF in RA. • Aging and sarcopenia are risk factors for VF in RA patients, and sarcopenia were associated with disease activity and structural damage.
探讨维生素 D 缺乏症和肌肉减少症对类风湿关节炎（RA）患者椎体骨质疏松性骨折（VF）的协同作用。
共纳入 188 例 RA 患者和 158 例对照者。采用双能 X 射线吸收法（DXA）和生物电阻抗分别测量总髋部、股骨颈、腰椎 1-4 及骨骼肌质量的骨矿物质密度（BMD）。采用电化学发光法检测血清 25（OH）D。比较 RA 患者和对照者的 VF 和骨质疏松症（OP）患病率。采用卡方检验和 logistic 回归检验 RA 患者中肌肉减少症和维生素 D 缺乏症对 VF 的协同作用。
RA 患者所有测量部位的 OP 患病率和 VF 患病率均高于对照者（P<0.0001）。RA 患者既有肌肉减少症又有维生素 D 缺乏症的 VF 发生率高于既无肌肉减少症又无维生素 D 缺乏症的患者（卡方=5.069，P=0.027，卡方=8.822，P=0.001）。有肌肉减少症或无肌肉减少症的 RA 患者的年龄、病程、C 反应蛋白（CRP）、红细胞沉降率（ESR）、DAS28、健康评估问卷（HAQ）、Sharp 评分和体重指数（BMI）差异均有统计学意义（P<0.05）。logistic 回归分析发现，年龄（OR=1.095，95%CI：1.044-1.150，P<0.0001）是 RA 患者 VF 的显著危险因素，而高骨骼肌质量（SMI）（OR=0.513，95%CI：0.327-0.804，P=0.004）是 RA 患者 VF 的保护因素。
VF、肌肉减少症和维生素 D 缺乏症在 RA 患者中很常见。肌肉减少症和维生素 D 缺乏症可能是 RA 患者 VF 发生率的危险因素。
RA 患者的 OP 和 VF 发生率较高，肌肉减少症和维生素 D 缺乏症的患病率也较高。
维生素 D 缺乏症和肌肉减少症可能对 RA 患者的 VF 有协同作用。
年龄增长和肌肉减少症是 RA 患者 VF 的危险因素，肌肉减少症与疾病活动度和结构损伤有关。
