Association between Bone Mineral Density and Body Composition in South Indian Rheumatoid Arthritis Patients: A Cross Sectional Study

Abstract

Objectives:

The aim of the present study was to compare and correlate body composition measurements and bone mineral density in patients with rheumatoid arthritis (RA) and age-matched controls to identify the possible prediction factors for low bone mass, and body composition changes.

Methods:

92 RA patients and 92 age- and sex-matched healthy controls were included for the study. The following assessments as well as measurements were carried out in each individual in a standard way: i) health assessment questionnaire (HAQ) score, ii) disease activity score (DAS-28), iii) forearm ulna bone mineral density (BMD) using dual energy x-ray absorptiometry (DXA), iv) estimated heel BMD using quantitative ultrasound, v) body composition parameters using bioelectrical impedence analysis, and vi) blood analysis using biochemical methods.

Results:

Body fat mass (BFM) differed significantly between RA patient group (26.37±10.05 (kg)) and normal controls (30.11±8.64 (kg), <0.05). The Fat free mass (FFM) was also significantly different between RA patients (37.63±9.82 kg) and controls (42.97±6.68 kg, p<0.01). Forearm BMD and estimated heel BMD was significantly higher in controls (0.377±0.04 g/cm²; 0.493±0.08 g/cm²), than in RA patients (0.320±0.13 g/cm², 0.452±0.10 g/cm²; p<0.01 and p<0.05, respectively). The Fat free mass (FFM), muscle mass (MM), segmental muscle mass (SMM) were significantly correlated with the estimated heel BMD as well as forearm BMD.

Conclusions:

These findings indicated that the body composition measurements might be useful for predicting bone mineral density (BMD) in RA patients. High RA activity was found to be associated with reduced function, and altered body composition and BMD.

Zusammenfassung

Zielsetzung:

Ziel der Studie war es, die Körperkomposition und Knochenmineraldichte von Patienten mit rheumatoider Arthritis (RA Patienten) mit denen gesunder gleichaltriger Kontrollpersonen zu vergleichen, um potenzielle prädikative Faktoren für geringere Knochendichte und Veränderungen der Körperkomposition zu identifizieren.

Methodik:

Die Studie umfasste 92 RA Patienten und 92 gesunde Kontrollpersonen gleichen Alters und Geschlechts. Alle Messungen wurden mit standardisierter Messmethoden vorgenommen. Folgenden Bewertungen und Messungen wurden bei allen Studienteilnehmern durchgeführt: (i) Bewertung des Gesundheitsstatus mithilfe des HAQ-(Health Assessment Questionnaire-)Fragebogens, (ii) Beurteilung des Krankheitszustands anhand der DAS-28 (Disease Activity Score), (iii) Messung der Knochenmineraldichte (KMD) des Unterarms mit Dual-Energie-Röntgen-Absorp­tiometrie (DEXA), (iv) Schätzung der KMD der Ferse mithilfe quantitativer Ultraschallmessungen, (v) Messung der Körperkomposition mithilfe bioelektrischer Widerstandsanalyse, sowie (vi) eine biochemische Blutanalyse.

Ergebnisse:

Die durchschnittliche Körperfettmasse (KFM) in der RA-Patientengruppe [26,37±10,05 (kg)] unterschied sich signifikant von der KFM der Kontrollgruppe [30,11±8,64 (kg), p<0,05]. Auch die fettfreie Masse (FFM) von RA-Patienten (37,63±9,82 kg) unterschied sich signifikant von der FFM der Kontrollgruppe (42,97±6,68 kg, p <0,01). KMD des Unterarms und geschätzte KMD der Ferse waren signifikant höher in der Kontrollgruppe (0,377±0,04 g/cm² bzw. 0,493±0,08 g/cm²) verglichen mit der Gruppe der RA-Patienten (0,320±0,13 g/cm² bzw. 0,452±0,10 g/cm²; p <0,01 bzw. p<0,05). Die fettfreie Masse (FFM), Muskelmasse (MM) und Segmentmuskelmasse (SMM) korrelierten signifikant mit der geschätzten KMD der Ferse und der gemes­senen KMD des Unterarms.

Schlussfolgerung:

Diese Ergebnisse weisen darauf hin, dass Messungen zur Feststellung der Körperkomposition sinnvoll sein könnten, zur besseren Vorhersage von Knochenmineraldichten (KMD) von Patienten mit rheumatoider Arthritis. Waren Patienten stärker von RA betroffen, so ging diese stärkere Erkrankung mit einer Einschränkung ihrer Funktionen sowie Veränderungen der Körperkomposition und der KMD einher.

Key words

body composition analysis - bone mineral density - health assessment ­questionnaire - quantitative ultrasound - rheumatoid arthritis

Schlüsselwörter

rheumatoide Arthritis - Knochenmineraldichte - Körperkomposition

• References

• 1 Oliver J, Kladosek A, Weiler V et al. Rheumatoid Arthritis: A Practical Guide to State-of-the-Art Imaging, Image Interpretation, and Clinical Implications. Radio Graphics 2005; 25: 381-398
• 2 Haugeberg G, Orstavik RE, Uhlig T et al. Bone loss in patients with rheumatoid arthritis. Arthritis Rheum 2002; 46: 1720-1728
• 3 Gough AKS, Emery P, Holder RL et al. Generalized bone loss in patients with early rheumatoid arthritis. Lancet 1994; 344: 23-27
• 4 Iwamoto J, Takeda T, Ichimura S et al. Forearm bone mineral density in patients with rheumatoid arthritis. J Orthop Sci 2002; 7: 528-534
• 5 Hill CL, Schultz CG, Rodney WU et al. Measurement of hand bone mineral density in early rheumatoid arthritis using dual energy X-ray absorptiometry. Int J Rheum Dis 2010; 13: 230-234
• 6 Snekhalatha U, Anburajan M. Evaluation of functional ability of rheumatoid arthritis patients using HAQ score and BMD in south Indian rheumatoid arthritis. Rheumatology Int 2012; 32: 1997-2004
• 7 Westhovens R, Nijs J, Taelman V et al. Body composition in rheumatoid arthritis. Br J Rheumatol 1997; 36: 444-448
• 8 Roubenoff R, Roubenoff RA, Ward LM et al Rheumatoid cachexia: depletion of lean body mass in rheumatoid arthritis. Possible association with tumor necrosis factor. J Rheumatol 1992; 19: 1505-1510
• 9 Gallagher D, Song MY. Evaluation of body composition: practical guidelines. Prim Care 2003; 30: 249-265
• 10 Vasudev S, Mohan A, Mohan D et al Validation of body fat measurement by skin folds and two bioelectric impedance methods with DEXA – the Chennai Urban Rural Epidemiology Study [CURES-3]. J Assoc Phys India 2004; 52: 877-881
• 11 Fogelholm M, Lichtenbelt VMW. Comparison of body composition methods: a literature analysis. Eur J Clin Nutr 1997; 51: 495-503
• 12 Mok C, Chi Ho Y. et al. Bone mineral density and body composition in systemic sclerosis: A case control study. Arthritis Rheum 2010; 62: 1206
• 13 Marcora S, Casanova F, Williams E et al. Preliminary evidence for cachexia in patients with well established ankylosing spondylitis. Rheumatology 2006; 45: 1385-1388
• 14 Book C, Karlsson MK, Kesson KA et al. Early rheumatoid arthritis and body composition. Rheumatology 2009; 48: 1128-1132
• 15 Shahrir M Eishwary M, Shahid S. et al. Correlation between CCP Levels and Health Assessment Questionnaire in Rheumatoid Arthritis: A Single Center Analysis. The Internet Journal of Rheumatology 2007; 4
• 16 Fransen J, van Riel PLCM. The disease activity score and EULAR response criteria. Clin Exp Rheumatol 2005; 23: 93-99
• 17 Online Disease activity score calculator for rheumatoid arthritis, available from http://www.das-score.nl Accessed on 2011
• 18 Toyoda T, Inokuchi S, Saito S et al. Bone loss of the radius in rheumatoid arthritis. Comparison between 34 patients and 40 controls. Acta Orthop Scand 1996; 67: 269-273
• 19 Kelly CA, Bartholomewc P, Lapworthc A et al. Peripheral bone density in patients with rheumatoid arthritis and factors which influence it. Eur J Intern Med 2002; 13: 423-427
• 20 Frediani A, Allegri P, Falsetti P et al. Bone mineral density in patients with psoriatic arthritis. J Rheumatol 2001; 28: 138-143
• 21 Aggarwal P, Aggarwal A, Gupta S et al. Osteopenia is common in male adult patients with active juvenile idiopathic arthritis. J Rheumatol 2006; 33: 1642-1645
• 22 Cryer JR, Otter SJ, Bowen CJ. Use of Quantitative Ultrasound Scans of the Calcaneus to Diagnose Osteoporosis in Patients with Rheumatoid Arthritis. JAPMA 2007; 97: 108-114
• 23 Pedreira PG, Pinheiro MM, Szejnfeld VL. Bone mineral density and body composition in postmenopausal women with psoriasis and psoriatic arthritis. Arthritis Res Ther 2011; 1: R16 [Epub ahead of print]
• 24 Benetos A, Zervoudaki A, Kearney-Schwart A et al. Effects of lean and fat mass on bone mineral density and arterial stiffness in elderly men. Osteoporos Int 2009; 20: 1385-1391
• 25 Zhao LJ, Liu YJ, Liu PY et al. Relationship of obesity with osteoporosis. J Clin Endocrinol Metab 2007; 92: 1640-1646
• 26 Plasqui G. The role of physical activity in rheumatoid arthritis. Physiol Behav 2008; 94: 270-275
• 27 Roubenoff R. Rheumatoid cachexia: a complication of rheumatoid arthritis moves into 21^st century. Arthritis Res Ther 2009; 11: 108
• 28 Munro R, Capell H. Prevalence of low body mass in rheumatoid arthritis: association with the acute phase response. Ann Rheum dis 1997; 56: 326-329
• 29 Association of body composition with disability in rheumatoid arthritis: impact of appendicular fat and lean tissue mass. Available from http://www.medscape.com/view article/581317. Accessed on 2011
• 30 Engvall IL, Brismar K, Hafstrom I et al. Treatment with low-dose Prednisolone is associated with altered body composition but no difference in bone mineral density in rheumatoid arthritis patients: a controlled cross-sectional study. Scand J Rheumatol 2011; 40: 161-168
• 31 Engvall IL, Tengstrand B, Brismar K et al. Infliximab therapy increases body fat mass in early rheumatoid arthritis independently of changes in disease activity and levels of leptin and adiponectinia randomized study over 21 months. Arthritis Research & Therapy 2010; 12: R197
• 32 Sarkis KS, Salvador MB, Pinheiro MM et al. Association between Osteoporosis and Rheumatoid Arthritis in women: a cross sectional study. Sao Paulo Med J 2009.
• 33 Giles JT, Ling SM, Ferrucci L et al. Abnormal body composition phenotypes in older rheumatoid arthritis: association with disease characteristics and pharmacotherapies. Arthritis Rheum 2008; 59: 807-815
• 34 Giles JT, Barlett SJ, Andersen RE et al. Association of body composition with disability in Rheumatoid arthritis: Impact of Appendicular fat and lean tissue mass. Arthritis Rheum. 2008. 59. 1407-1415
• 35 Silva RG, Pippa MG, Zerbin CA. Evaluation of body composition and bone mineral density in women with rheumatoid arthritis. Rev Assoc Med Bras 2007; 53: 135-141
• 36 Toussirot E, Nguyen NU, Dumoulin G et al. Relationship between growth hormone-IGF-I-IGFBP-3 axis and serum leptin levels with bone mass and body composition in patients with rheumatoid arthritis. Rheumatology 2005; 44: 120-125
• 37 Sambrook PN, Spector TD, Seemam E et al. Osteoporosis in Rheumatoid arthritis A monozygotic co-Twin control study. Arthritis Rheum 1995; 38: 806-809