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Damaged bone microarchitecture by Trabecular Bone Score (TBS) and low appendicular muscle mass: main risk factors for vertebral and non-vertebral fractures in women with long-standing rheumatoid arthritis

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Abstract

Summary

We ascertained the fracture risk factors stratified by vertebral and non-vertebral sites in rheumatoid arthritis (RA) females. Bone/muscle features, but not disease activity, were the main markers for fractures in this long-standing RA population: low trabecular bone score (TBS) for vertebral fracture and decreased appendicular muscle mass for non-vertebral fracture.

Purpose

To assess risk factors for fractures, including clinical, laboratory and dual energy X-ray absorptiometry (DXA) parameters (bone mass, trabecular bone score—TBS, muscle mass) in women with established rheumatoid arthritis (RA).

Methods

Three hundred females with RA (ACR, 2010) were studied. Clinical data were obtained by questionnaire and disease activity by composite indices (DAS28, CDAI, SDAI), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Bone mineral density (BMD), TBS, body composition and Vertebral Fracture Assessment (VFA) were performed by DXA. Logistic regression models were constructed to identify factors independently associated with vertebral (VF) and non-vertebral fractures (NVF), separately.

Results

Through rigorous eligibility criteria, a total of 265 women were yielded for final data analysis (median age, 55 [22–86] years; mean disease duration, 16.2 years). Prevalence of VF and NVF were 30.6% and 17.4%, respectively. In multivariate analyzes, TBS (OR = 1.6, 95%CI = 1.09–2.36, p = 0.017), CRP (OR = 1.54, 95%CI = 1.15–2.08, p = 0.004), and parathormone (OR = 1.24, 95%CI = 1.05–1.45, p = 0.009) were risk factors for VF, whereas low appendicular muscle mass (OR = 2.71; 95%CI = 1.01–7,28; p = 0.048), body mass index (BMI) (OR = 0.90, 95%CI = 0.82–0.99; p = 0.025), ESR (OR = 1.18, 95%CI = 1.01–1,38, p = 0,038) and hip BMD (OR = 1.82, 95%CI = 1.10–3.03, p = 0.02) were associated with NVF.

Conclusion

In women with long-term RA, markers of fractures differed between distinct skeletal sites (vertebral and non-vertebral). The magnitude of association of bone/muscle parameters with fracture (TBS for VF and appendicular muscle mass for NVF) was greater than that of the association between RA activity and fracture. TBS seems to have greater discriminative power than BMD to identify subjects with VF in long-standing RA.

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Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, Brazil

    Felipe F. Silva, Gisela R. Machado, Ana C. M. Ribeiro, Karina R. Bonfiglioli, Andrea Y. Shimabuco, Rosa M. R. Pereira & Diogo S. Domiciano

  2. Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, SP, Brazil

    Camille P. Figueiredo, Liliam M. T. Guerra, Valéria F. Caparbo, Rosa M. R. Pereira & Diogo S. Domiciano

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  1. Felipe F. Silva
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  2. Gisela R. Machado
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Corresponding author

Correspondence to Diogo S. Domiciano.

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Ethics approval

This study was approved by the Local Ethics in Research Committee of the São Paulo University School of Medicine (CAPPesq: 51178115.1.0000.0068).

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All participants gave written informed consent.

Conflicts of interest

FFS, GRM, ACMR, AYS, CPF, LMTG, VFC, RMRP have nothing to declare. KRB has received a speaker honorarium from Abbvie, Pfizer and Novartis. DSD has received a speaker honorarium from Amgen and Janssen.

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Silva, F.F., Machado, G.R., Ribeiro, A.C.M. et al. Damaged bone microarchitecture by Trabecular Bone Score (TBS) and low appendicular muscle mass: main risk factors for vertebral and non-vertebral fractures in women with long-standing rheumatoid arthritis. Osteoporos Int 35, 819–830 (2024). https://doi.org/10.1007/s00198-024-07026-3

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