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Abstract Number: 0108

The Relationship Between Body Fat Percentage and Bone Mineral Density in Rheumatoid Arthritis Patients

Anastasia- Vasiliki Madenidou1 and Marwan Bukhari2, 1Rheumatology Department, University Hospitals of Morecambe Bay NHS Trust, Barrow-in-Furness, United Kingdom, 2Rheumatology Department, University Hospitals of Morecambe Bay NHS Trust, Lancaster, United Kingdom

Meeting: ACR Convergence 2020

Keywords: body mass, Bone density, Dual energy x-ray absorptiometry (DEXA), osteoporosis, rheumatoid arthritis

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Session Information

Date: Friday, November 6, 2020

Session Title: Osteoporosis & Metabolic Bone Disease Poster

Session Type: Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Currently, Dual-Energy X-ray Absorptiometry (DEXA) scans are used to determine fracture risk by calculating Bone Mineral Density (BMD). It is well established that body weight is one of the strongest predictors of bone mass, but there is ongoing controversy as to whether fat mass is a better predictor of bone density. Our research set out to find out whether there is association between body fat percentage and BMD in patients with rheumatoid arthritis stratified by steroid use.

Methods: Data were used from a cohort of rheumatoid arthritis (RA) patients referred for DEXA scan to a District General Hospital between 2004 and 2010. The following were recorded: age, sex, weight, height, body mass index (BMI), BMD at L1-L4, BMD at femoral neck (left and right) and BMD at hip (left and right). Multivariate linear regression was used to identify associations between body fat percentage and BMD at L1, L2, L3, L4, right neck of femur and left neck of femur in RA patient on steroids or not. Data was adjusted for age, sex, weight, height and BMI at scan.

Results: 1,527 patients were used in the study. 79% were female and mean age was 64.3 years (SD 11.6). Mean height was 1.62 m (SD 8.57), mean weight was 71.6 kg (SD 16.4 SD) and mean BMI was 26.8 kg/cm2 (SD 5.2). The results of BMD are presented in Table 1. The results of the linear regression analysis of the relationships between fat percentage and BMD at each level are presented in the Table 2.

Conclusion: This study identifies that fat percentage is a predictor of the bone density at L1- L3 in RA patients on steroids. This association reflects how steroids affect the bone metabolism in different regions of the skeleton as bone loss is more marked in the trabecular bone (high content in vertebrae) in patients on steroids. The fat distribution may change in patients on steroids who can develop central obesity with the lower limbs spared and even wasted. This altered fat distribution may explain the association of fat percentage and bone density at a lumbar spine level and not at neck or hip level. Our results also suggest that the Fracture Risk Assessment (FRAX) tool underestimates the risk of fracture in patients on steroids as it takes into consideration the bone density at the femoral neck and not at the lumbar spine.We suggest further research in finding better tools for assessing fracture risk in glucocorticoid- induced osteoporosis.


Disclosure: A. Madenidou, None; M. Bukhari, Bristol- Myers Squib, 1, UCB celltech, 1, 2, Roche, 1, 2, Abbvie, 1, 2, Merck, 1, 2, Mennarini, 1, 2, Sanofi-aventis, 1, 2, Elli-Lilly, 1, 2, Janseen, 1, Amgen, 1, 2, Novartis, 1, 2.

To cite this abstract in AMA style:

Madenidou A, Bukhari M. The Relationship Between Body Fat Percentage and Bone Mineral Density in Rheumatoid Arthritis Patients [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/the-relationship-between-body-fat-percentage-and-bone-mineral-density-in-rheumatoid-arthritis-patients/. Accessed February 27, 2021.
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