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Baker JF, Long J, Mostoufi-Moab S, Denburg M, Jorgenson E, Sharma P, Zemel BS, Taratuta E, Ibrahim S, Leonard MB. Muscle Deficits in Rheumatoid Arthritis Contribute to Inferior Cortical Bone Structure and Trabecular Bone Mineral Density. J Rheumatol 2017; 44:1777-1785. [PMID: 28916544 DOI: 10.3899/jrheum.170513] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) is associated with muscle loss, osteoporosis, and fracture. We examined associations between skeletal muscle mass, strength, and quality and trabecular and cortical bone deficits in patients with RA and healthy controls. METHODS Participants, ages 18-75 years, completed whole-body dual-energy x-ray absorptiometry and peripheral quantitative computed tomography (pQCT) of the tibia to quantify appendicular lean mass and fat mass indices (ALMI, FMI), muscle density at the lower leg, trabecular bone density, and cortical bone thickness. Age-, sex-, and race-specific Z scores were calculated based on distributions in controls. Associations between body composition and pQCT bone outcomes were assessed in patients with RA and controls. Linear regression analyses assessed differences in bone outcomes after considering differences in body mass index (BMI) and body composition. RESULTS The sample consisted of 112 patients with RA (55 men) and 412 controls (194 men). Compared to controls, patients with RA had greater BMI Z score (p < 0.001), lower ALMI Z score after adjustment for FMI (p = 0.02), lower muscle strength Z score (p = 0.01), and lower muscle density Z score (p < 0.001). Among RA, ALMI Z scores were positively associated with trabecular density [β: 0.29 (0.062-0.52); p = 0.01] and cortical thickness [β: 0.33 (0.13-0.53; p = 0.002]. Associations were similar in controls. Bone outcomes were inferior in patients with RA after adjusting for BMI, but similar to controls when adjusting for body composition. Radiographic damage and higher adiponectin levels were independently associated with inferior bone outcomes. CONCLUSION Patients with RA exhibit deficits in cortical bone structure and trabecular density at the tibia and a preserved functional muscle-bone unit. A loss of mechanical loading may contribute to bone deficits.
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Affiliation(s)
- Joshua F Baker
- From the Division of Rheumatology, and Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center; Department of Epidemiology, Biostatistics, and Informatics, and the Department of Radiology, University of Pennsylvania; Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Stanford University, Palo Alto, California, USA. .,J.F. Baker, MD, MSCE, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center, Division of Rheumatology, and the Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; J. Long, PhD, Department of Pediatrics, Stanford University; S. Mostoufi-Moab, MD, MSCE, Department of Pediatrics, Children's Hospital of Philadelphia; M. Denburg, MD, MSCE, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania, Department of Pediatrics, and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia; E. Jorgenson, MPH, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; P. Sharma, BA, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center; B.S. Zemel, PhD, Department of Pediatrics, Children's Hospital of Philadelphia; E. Taratuta, MD, Department of Radiology, University of Pennsylvania; S. Ibrahim, MD, MPH, MBA, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center; M.B. Leonard, MD, MSCE, Department of Pediatrics, Stanford University.
| | - Jin Long
- From the Division of Rheumatology, and Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center; Department of Epidemiology, Biostatistics, and Informatics, and the Department of Radiology, University of Pennsylvania; Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Stanford University, Palo Alto, California, USA.,J.F. Baker, MD, MSCE, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center, Division of Rheumatology, and the Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; J. Long, PhD, Department of Pediatrics, Stanford University; S. Mostoufi-Moab, MD, MSCE, Department of Pediatrics, Children's Hospital of Philadelphia; M. Denburg, MD, MSCE, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania, Department of Pediatrics, and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia; E. Jorgenson, MPH, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; P. Sharma, BA, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center; B.S. Zemel, PhD, Department of Pediatrics, Children's Hospital of Philadelphia; E. Taratuta, MD, Department of Radiology, University of Pennsylvania; S. Ibrahim, MD, MPH, MBA, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center; M.B. Leonard, MD, MSCE, Department of Pediatrics, Stanford University
| | - Sogol Mostoufi-Moab
- From the Division of Rheumatology, and Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center; Department of Epidemiology, Biostatistics, and Informatics, and the Department of Radiology, University of Pennsylvania; Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Stanford University, Palo Alto, California, USA.,J.F. Baker, MD, MSCE, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center, Division of Rheumatology, and the Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; J. Long, PhD, Department of Pediatrics, Stanford University; S. Mostoufi-Moab, MD, MSCE, Department of Pediatrics, Children's Hospital of Philadelphia; M. Denburg, MD, MSCE, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania, Department of Pediatrics, and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia; E. Jorgenson, MPH, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; P. Sharma, BA, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center; B.S. Zemel, PhD, Department of Pediatrics, Children's Hospital of Philadelphia; E. Taratuta, MD, Department of Radiology, University of Pennsylvania; S. Ibrahim, MD, MPH, MBA, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center; M.B. Leonard, MD, MSCE, Department of Pediatrics, Stanford University
| | - Michele Denburg
- From the Division of Rheumatology, and Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center; Department of Epidemiology, Biostatistics, and Informatics, and the Department of Radiology, University of Pennsylvania; Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Stanford University, Palo Alto, California, USA.,J.F. Baker, MD, MSCE, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center, Division of Rheumatology, and the Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; J. Long, PhD, Department of Pediatrics, Stanford University; S. Mostoufi-Moab, MD, MSCE, Department of Pediatrics, Children's Hospital of Philadelphia; M. Denburg, MD, MSCE, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania, Department of Pediatrics, and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia; E. Jorgenson, MPH, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; P. Sharma, BA, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center; B.S. Zemel, PhD, Department of Pediatrics, Children's Hospital of Philadelphia; E. Taratuta, MD, Department of Radiology, University of Pennsylvania; S. Ibrahim, MD, MPH, MBA, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center; M.B. Leonard, MD, MSCE, Department of Pediatrics, Stanford University
| | - Erik Jorgenson
- From the Division of Rheumatology, and Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center; Department of Epidemiology, Biostatistics, and Informatics, and the Department of Radiology, University of Pennsylvania; Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Stanford University, Palo Alto, California, USA.,J.F. Baker, MD, MSCE, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center, Division of Rheumatology, and the Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; J. Long, PhD, Department of Pediatrics, Stanford University; S. Mostoufi-Moab, MD, MSCE, Department of Pediatrics, Children's Hospital of Philadelphia; M. Denburg, MD, MSCE, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania, Department of Pediatrics, and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia; E. Jorgenson, MPH, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; P. Sharma, BA, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center; B.S. Zemel, PhD, Department of Pediatrics, Children's Hospital of Philadelphia; E. Taratuta, MD, Department of Radiology, University of Pennsylvania; S. Ibrahim, MD, MPH, MBA, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center; M.B. Leonard, MD, MSCE, Department of Pediatrics, Stanford University
| | - Prerna Sharma
- From the Division of Rheumatology, and Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center; Department of Epidemiology, Biostatistics, and Informatics, and the Department of Radiology, University of Pennsylvania; Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Stanford University, Palo Alto, California, USA.,J.F. Baker, MD, MSCE, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center, Division of Rheumatology, and the Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; J. Long, PhD, Department of Pediatrics, Stanford University; S. Mostoufi-Moab, MD, MSCE, Department of Pediatrics, Children's Hospital of Philadelphia; M. Denburg, MD, MSCE, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania, Department of Pediatrics, and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia; E. Jorgenson, MPH, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; P. Sharma, BA, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center; B.S. Zemel, PhD, Department of Pediatrics, Children's Hospital of Philadelphia; E. Taratuta, MD, Department of Radiology, University of Pennsylvania; S. Ibrahim, MD, MPH, MBA, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center; M.B. Leonard, MD, MSCE, Department of Pediatrics, Stanford University
| | - Babette S Zemel
- From the Division of Rheumatology, and Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center; Department of Epidemiology, Biostatistics, and Informatics, and the Department of Radiology, University of Pennsylvania; Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Stanford University, Palo Alto, California, USA.,J.F. Baker, MD, MSCE, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center, Division of Rheumatology, and the Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; J. Long, PhD, Department of Pediatrics, Stanford University; S. Mostoufi-Moab, MD, MSCE, Department of Pediatrics, Children's Hospital of Philadelphia; M. Denburg, MD, MSCE, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania, Department of Pediatrics, and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia; E. Jorgenson, MPH, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; P. Sharma, BA, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center; B.S. Zemel, PhD, Department of Pediatrics, Children's Hospital of Philadelphia; E. Taratuta, MD, Department of Radiology, University of Pennsylvania; S. Ibrahim, MD, MPH, MBA, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center; M.B. Leonard, MD, MSCE, Department of Pediatrics, Stanford University
| | - Elena Taratuta
- From the Division of Rheumatology, and Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center; Department of Epidemiology, Biostatistics, and Informatics, and the Department of Radiology, University of Pennsylvania; Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Stanford University, Palo Alto, California, USA.,J.F. Baker, MD, MSCE, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center, Division of Rheumatology, and the Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; J. Long, PhD, Department of Pediatrics, Stanford University; S. Mostoufi-Moab, MD, MSCE, Department of Pediatrics, Children's Hospital of Philadelphia; M. Denburg, MD, MSCE, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania, Department of Pediatrics, and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia; E. Jorgenson, MPH, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; P. Sharma, BA, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center; B.S. Zemel, PhD, Department of Pediatrics, Children's Hospital of Philadelphia; E. Taratuta, MD, Department of Radiology, University of Pennsylvania; S. Ibrahim, MD, MPH, MBA, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center; M.B. Leonard, MD, MSCE, Department of Pediatrics, Stanford University
| | - Said Ibrahim
- From the Division of Rheumatology, and Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center; Department of Epidemiology, Biostatistics, and Informatics, and the Department of Radiology, University of Pennsylvania; Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Stanford University, Palo Alto, California, USA.,J.F. Baker, MD, MSCE, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center, Division of Rheumatology, and the Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; J. Long, PhD, Department of Pediatrics, Stanford University; S. Mostoufi-Moab, MD, MSCE, Department of Pediatrics, Children's Hospital of Philadelphia; M. Denburg, MD, MSCE, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania, Department of Pediatrics, and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia; E. Jorgenson, MPH, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; P. Sharma, BA, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center; B.S. Zemel, PhD, Department of Pediatrics, Children's Hospital of Philadelphia; E. Taratuta, MD, Department of Radiology, University of Pennsylvania; S. Ibrahim, MD, MPH, MBA, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center; M.B. Leonard, MD, MSCE, Department of Pediatrics, Stanford University
| | - Mary B Leonard
- From the Division of Rheumatology, and Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center; Department of Epidemiology, Biostatistics, and Informatics, and the Department of Radiology, University of Pennsylvania; Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Stanford University, Palo Alto, California, USA.,J.F. Baker, MD, MSCE, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center, Division of Rheumatology, and the Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; J. Long, PhD, Department of Pediatrics, Stanford University; S. Mostoufi-Moab, MD, MSCE, Department of Pediatrics, Children's Hospital of Philadelphia; M. Denburg, MD, MSCE, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania, Department of Pediatrics, and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia; E. Jorgenson, MPH, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; P. Sharma, BA, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center; B.S. Zemel, PhD, Department of Pediatrics, Children's Hospital of Philadelphia; E. Taratuta, MD, Department of Radiology, University of Pennsylvania; S. Ibrahim, MD, MPH, MBA, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center; M.B. Leonard, MD, MSCE, Department of Pediatrics, Stanford University
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