{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T21:55:08Z","timestamp":1784325308652,"version":"3.55.0"},"reference-count":49,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2018,5,9]],"date-time":"2018-05-09T00:00:00Z","timestamp":1525824000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P60\u2010AR\u2010053308"],"award-info":[{"award-number":["P60\u2010AR\u2010053308"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis Care &amp; Research"],"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Osteoporotic fractures are associated with high morbidity and mortality. Persons with rheumatoid arthritis (<jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content>) have twice the risk of osteoporosis\u2010related fracture than age\u2010matched controls, the causes for which remain unknown. We investigated contributions of <jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content> characteristics, medication use, and body composition to low bone mineral density (<jats:styled-content style=\"fixed-case\">BMD<\/jats:styled-content>) in patients with <jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data were from the Arthritis, Body Composition, and Disability Study (n = 138; 82 women, 56 men). Demographic, clinical, laboratory, and functional variables were collected at study visits. Body composition (fat, lean muscle, and <jats:styled-content style=\"fixed-case\">BMD<\/jats:styled-content>) was measured by dual x\u2010ray absorptiometry. Linear regression analyses evaluated the association between predictors and femoral neck <jats:styled-content style=\"fixed-case\">BMD<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Average disease duration was 19 years, 70% of patients were rheumatoid factor positive, and 55% were high\u2010positive anti\u2013cyclic citrullinated peptide (anti\u2010<jats:styled-content style=\"fixed-case\">CCP<\/jats:styled-content>). Age and high anti\u2010<jats:styled-content style=\"fixed-case\">CCP<\/jats:styled-content> positivity were negatively associated with <jats:styled-content style=\"fixed-case\">BMD<\/jats:styled-content> after controlling for other variables (\u03b2 = \u22120.003 and \u22120.055, respectively, <jats:italic>P<\/jats:italic> &lt; 0.05). Appendicular lean mass index (<jats:styled-content style=\"fixed-case\">ALMI<\/jats:styled-content>) was positively associated with <jats:styled-content style=\"fixed-case\">BMD<\/jats:styled-content> (\u03b2 = 0.053, <jats:italic>P<\/jats:italic> &lt; 0.0001). In high anti\u2010<jats:styled-content style=\"fixed-case\">CCP<\/jats:styled-content> positivity participants, increasing anti\u2010<jats:styled-content style=\"fixed-case\">CCP<\/jats:styled-content> levels were associated with a negative linear trend in <jats:styled-content style=\"fixed-case\">BMD<\/jats:styled-content> (\u03b2 = \u22120.011, <jats:italic>P<\/jats:italic> = 0.026).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>High anti\u2010<jats:styled-content style=\"fixed-case\">CCP<\/jats:styled-content> positivity and <jats:styled-content style=\"fixed-case\">ALMI<\/jats:styled-content> were strongly associated with <jats:styled-content style=\"fixed-case\">BMD<\/jats:styled-content> in patients with <jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content>. The linear relationship of anti\u2010<jats:styled-content style=\"fixed-case\">CCP<\/jats:styled-content> levels with lower <jats:styled-content style=\"fixed-case\">BMD<\/jats:styled-content> supports the hypothesis that processes specific to <jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content> negatively impact <jats:styled-content style=\"fixed-case\">BMD<\/jats:styled-content>. In contrast, <jats:styled-content style=\"fixed-case\">ALMI<\/jats:styled-content> was positively associated with <jats:styled-content style=\"fixed-case\">BMD<\/jats:styled-content>, emphasizing the importance of this potentially modifiable risk factor. Our findings highlight the complicated interplay of <jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content> disease\u2010specific and functional factors and their impact on bone mass.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.23440","type":"journal-article","created":{"date-parts":[[2017,11,5]],"date-time":"2017-11-05T01:02:38Z","timestamp":1509843758000},"page":"961-969","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Association of High Anti\u2013Cyclic Citrullinated Peptide Seropositivity and Lean Mass Index With Low Bone Mineral Density in Rheumatoid Arthritis"],"prefix":"10.1002","volume":"70","author":[{"given":"Katherine D.","family":"Wysham","sequence":"first","affiliation":[{"name":"University of California San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dolores M.","family":"Shoback","sequence":"additional","affiliation":[{"name":"San Francisco Department of 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