| Objective To investigate the clinical value of sarcopenia and osteopenia/osteoporosis on spinal osteoporotic fractures in patients with rheumatoid arthritis (RA). Methods Three hundred and eighty-three patients with RA from January 2017 to December 2018 and 158 gender and age-matched normal subjects (control group) were enrolled in the study. Clinical and laboratory features, daily dosage, and treatment duration of glucocorticoid (GC) were recorded in detail. X-ray of posteroanterior and lateral of spine (from thoracic 5 to lumbar vertebra 5) were detected in all the individuals. Occurrence of spinal fracture was determined according to semiquantitative method. Skeletal muscle mass index (SMI) was measured by bioelectrical impedance analysis. Bone mineral density (BMD) at the lumbar vertebra were detected with dual energy X-ray absorptiometry (DEXA). All the RA patients were divided into 4 groups according to their SMI and BMD: 64 patients with neither sarcopenia nor osteopenia/osteoporosis, 44 patients with sarcopenia only, 86 patients with osteopenia/osteoporosis only, and 189 patients with both sarcopenia and osteopenia/osteoporosis. The clinical value of sarcopenia and osteopenia/osteoporosis on spinal osteoporotic fractures in patients with RA was investigated. Results The incidence of spinal fracture in RA group was significantly higher than that in control group (21.1% vs 3.8%, x2=24.954, P<0.001). RA group was more likely to develop osteopenia/osteoporosis and sarcopenia than that in control (71.8% vs 41.8%, x2=43.287, P<0.001; 60.8% vs 9.0%, x2=120.093, P<0.001, respectively). The incidence of spinal fractures in the 4 groups were also different (4.7%, 11.4%, 17.4%, and 30.7%, respectively, x2=23.947, P<0.001). Results of non-parametric test showed that joint tenderness count, tenderness index, erythrocyte sedimentation rate, DAS28, HAQ, sharp score, daily dosage, and treatment course of glucocorticoid were significantly different among the 4 groups (P<0.05). Multivariate logistic regression showed that age (OR=1.073, P<0.001, 95% CI: 1.041–1.107) and usage of glucocorticoid (OR=3.221, P=0.001, 95%CI:1.663–6.242) were risk factors for spinal fractures in RA patients, while BMD at L1-4 (OR=0.093, P=0.009, 95% CI:0.015–0.555) and SMI (OR=0.716, P=0.032, 95% CI:0.527–0.973) were protective factors for spinal fractures in RA patients. Conclusion RA patients are more likely to develop sarcopenia, osteopenia/osteoporosis, and spinal fractures. Sarcopenia and osteopenia/osteoporosis have an important value on spinal fractures in RA. |