{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T18:56:47Z","timestamp":1784141807353,"version":"3.55.0"},"reference-count":45,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,11,22]],"date-time":"2025-11-22T00:00:00Z","timestamp":1763769600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"},{"start":{"date-parts":[[2025,11,22]],"date-time":"2025-11-22T00:00:00Z","timestamp":1763769600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Osteoporos Int"],"published-print":{"date-parts":[[2026,1]]},"DOI":"10.1007\/s00198-025-07776-8","type":"journal-article","created":{"date-parts":[[2025,11,22]],"date-time":"2025-11-22T12:37:09Z","timestamp":1763815029000},"page":"179-189","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Loss of muscle and bone mass with increased adiposity and fractures in patients with chronic obstructive pulmonary disease: A 5-year follow-up cohort study"],"prefix":"10.1007","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-9170-9600","authenticated-orcid":false,"given":"Roberta Queiroz","family":"Graumam","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luiza V. A.","family":"Silva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0576-5816","authenticated-orcid":false,"given":"Marcela M. C.","family":"Pinheiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3137-6110","authenticated-orcid":false,"given":"Vera L.","family":"Szejnfeld","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9144-996X","authenticated-orcid":false,"given":"Charlles H. M.","family":"Castro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,22]]},"reference":[{"key":"7776_CR1","doi-asserted-by":"publisher","first-page":"147997231876976","DOI":"10.1177\/1479972318769763","volume":"16","author":"A Gupta","year":"2019","unstructured":"Gupta A, Greening NJ, Evans RA, Samuels A, Toms N, Steiner MC (2019) Prospective risk of osteoporotic fractures in patients with advanced chronic obstructive pulmonary disease. Chron Respir Dis 16:1479972318769763","journal-title":"Chron Respir Dis"},{"key":"7776_CR2","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1183\/09031936.50130408","volume":"34","author":"L Graat-Verboom","year":"2009","unstructured":"Graat-Verboom L, Wouters EF, Smeenk FW, van den Borne BE, Lunde R, Spruit MA (2009) Current status of research on osteoporosis in COPD: a systematic review. Eur Respir J 34:209\u2013218","journal-title":"Eur Respir J"},{"key":"7776_CR3","doi-asserted-by":"publisher","first-page":"111","DOI":"10.11005\/jbm.2016.23.3.111","volume":"23","author":"R Okazaki","year":"2016","unstructured":"Okazaki R, Watanabe R, Inoue D (2016) Osteoporosis associated with chronic obstructive pulmonary disease. J Bone Metab 23:111\u2013120","journal-title":"J Bone Metab"},{"key":"7776_CR4","first-page":"95","volume":"10","author":"G Hillas","year":"2015","unstructured":"Hillas G, Perlikos F, Tsiligianni I, Tzanakis N (2015) Managing comorbidities in COPD. Int J Chron Obstruct Pulmon Dis 10:95\u2013109","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"7776_CR5","doi-asserted-by":"publisher","first-page":"1457","DOI":"10.1007\/s00198-018-4483-z","volume":"29","author":"RQ Graumam","year":"2018","unstructured":"Graumam RQ, Pinheiro MM, Nery LE, Castro CHM (2018) Increased rate of osteoporosis, low lean mass, and fragility fractures in COPD patients: association with disease severity. Osteoporos Int 29:1457\u20131468","journal-title":"Osteoporos Int"},{"key":"7776_CR6","doi-asserted-by":"publisher","first-page":"2335","DOI":"10.2147\/COPD.S112142","volume":"11","author":"Y Yamauchi","year":"2016","unstructured":"Yamauchi Y, Yasunaga H, Sakamoto Y, Hasegawa W, Takeshima H, Urushiyama H, Jo T, Matsui H, Fushimi K, Nagase T (2016) Mortality associated with bone fractures in COPD patients. Int J Chron Obstruct Pulmon Dis 11:2335\u20132340","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"7776_CR7","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1016\/j.chest.2019.06.036","volume":"156","author":"YW Chen","year":"2019","unstructured":"Chen YW, Ramsook AH, Coxson HO, Bon J, Reid WD (2019) Prevalence and risk factors for osteoporosis in individuals with COPD: a systematic review and meta-analysis. Chest 156:1092\u20131110","journal-title":"Chest"},{"key":"7776_CR8","doi-asserted-by":"publisher","first-page":"1233","DOI":"10.1002\/jbmr.3429","volume":"33","author":"MJ van Dort","year":"2018","unstructured":"van Dort MJ, Geusens P, Driessen JH, Romme EA, Smeenk FW, Wouters EF, van den Bergh JP (2018) High imminent vertebral fracture risk in subjects with COPD with a prevalent or incident vertebral fracture. J Bone Miner Res 33:1233\u20131241","journal-title":"J Bone Miner Res"},{"key":"7776_CR9","doi-asserted-by":"publisher","first-page":"1015","DOI":"10.2147\/COPD.S242009","volume":"15","author":"J Recio Iglesias","year":"2020","unstructured":"Recio Iglesias J, D\u00edez-Manglano J, L\u00f3pez Garc\u00eda F, D\u00edaz Peromingo JA, Almagro P, Varela Aguilar JM (2020) Management of the COPD patient with comorbidities: an experts recommendation document. Int J Chron Obstruct Pulmon Dis 15:1015\u20131037","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"7776_CR10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbspin.2021.105249","volume":"89","author":"L Kakoullis","year":"2022","unstructured":"Kakoullis L, Sampsonas F, Karamouzos V et al (2022) The impact of osteoporosis and vertebral compression fractures on mortality and association with pulmonary function in COPD: a meta-analysis. Joint Bone Spine 89:105249","journal-title":"Joint Bone Spine"},{"key":"7776_CR11","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1007\/s00198-008-0680-5","volume":"20","author":"MM Pinheiro","year":"2009","unstructured":"Pinheiro MM, Ciconelli RM, Martini LA, Ferraz MB (2009) Clinical risk factors for osteoporotic fractures in Brazilian women and men: the Brazilian Osteoporosis Study (BRAZOS). Osteoporos Int 20:399\u2013408","journal-title":"Osteoporos Int"},{"key":"7776_CR12","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1111\/j.1532-5415.1991.tb01616.x","volume":"39","author":"D Podsiadlo","year":"1991","unstructured":"Podsiadlo D, Richardson S (1991) The timed \u201cUp & Go\u201d: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39:142\u2013148","journal-title":"J Am Geriatr Soc"},{"key":"7776_CR13","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1590\/S1517-86922003000300002","volume":"9","author":"A Florindo","year":"2003","unstructured":"Florindo A, Latorre M (2003) Validation and reliability of the Baecke questionnaire for the evaluation of habitual physical activity in adult men. Rev Bras Med Esporte 9:121\u2013128","journal-title":"Rev Bras Med Esporte"},{"key":"7776_CR14","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1016\/j.jocd.2013.01.005","volume":"16","author":"M Sousa","year":"2013","unstructured":"Sousa M, Pinheiro MM, Szejnfeld VL, Castro CH (2013) Body composition parameters in healthy Brazilian women differ from white, black, and Hispanic American women reference range. J Clin Densitom 16:360\u2013367","journal-title":"J Clin Densitom"},{"key":"7776_CR15","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1016\/j.jocd.2019.07.001","volume":"22","author":"CR Shuhart","year":"2019","unstructured":"Shuhart CR, Yeap SS, Anderson PA, Jankowski LG, Lewiecki EM, Morse LR, Rosen HN, Weber DR, Zemel BS, Shepherd JA (2019) Executive summary of the 2019 ISCD position development conference on monitoring treatment, DXA cross-calibration and least significant change, spinal cord injury, peri-prosthetic and orthopedic bone health, transgender medicine, and pediatrics. J Clin Densitom 22:453\u2013471","journal-title":"J Clin Densitom"},{"key":"7776_CR16","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1093\/gerona\/glu010","volume":"69","author":"SA Studenski","year":"2014","unstructured":"Studenski SA, Peters KW, Alley DE et al (2014) The FNIH sarcopenia project: rationale, study description, conference recommendations, and final estimates. J Gerontol A Biol Sci Med Sci 69:547\u2013558","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"7776_CR17","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1093\/ageing\/afq034","volume":"39","author":"AJ Cruz-Jentoft","year":"2010","unstructured":"Cruz-Jentoft AJ, Baeyens JP, Bauer JM et al (2010) Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing 39:412\u2013423","journal-title":"Age Ageing"},{"key":"7776_CR18","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1016\/j.jocd.2019.09.001","volume":"22","author":"LG Jankowski","year":"2019","unstructured":"Jankowski LG, Warner S, Gaither K, Lenchik L, Fan B, Lu Y, Shepherd J (2019) Cross-calibration, least significant change and quality assurance in multiple dual-energy X-ray absorptiometry scanner environments: 2019 ISCD official position. J Clin Densitom 22:472\u2013483","journal-title":"J Clin Densitom"},{"key":"7776_CR19","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1016\/j.jocd.2016.08.004","volume":"20","author":"LT Mendon\u00e7a","year":"2017","unstructured":"Mendon\u00e7a LT, Pinheiro MM, Szejnfeld VL, Castro CH (2017) Bone mass outcomes in patients with osteoporosis treated with risedronate after alendronate failure: a 12-month follow-up study. J Clin Densitom 20:44\u201349","journal-title":"J Clin Densitom"},{"key":"7776_CR20","doi-asserted-by":"publisher","first-page":"984","DOI":"10.1002\/jbmr.5650110716","volume":"11","author":"HK Genant","year":"1996","unstructured":"Genant HK, Jergas M, Palermo L, Nevitt M, Valentin RS, Black D, Cummings SR (1996) Comparison of semiquantitative visual and quantitative morphometric assessment of prevalent and incident vertebral fractures in osteoporosis the study of osteoporotic fractures research group. J Bone Miner Res 11:984\u2013996","journal-title":"J Bone Miner Res"},{"key":"7776_CR21","doi-asserted-by":"publisher","first-page":"1547","DOI":"10.1007\/s00198-008-0832-7","volume":"20","author":"S Kerkeni","year":"2009","unstructured":"Kerkeni S, Kolta S, Fechtenbaum J, Roux C (2009) Spinal deformity index (SDI) is a good predictor of incident vertebral fractures. Osteoporos Int 20:1547\u20131552","journal-title":"Osteoporos Int"},{"key":"7776_CR22","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1007\/BF01622200","volume":"4","author":"JA Kanis","year":"1994","unstructured":"Kanis JA (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO study group. Osteoporos Int 4:368\u2013381","journal-title":"Osteoporos Int"},{"key":"7776_CR23","doi-asserted-by":"publisher","first-page":"395","DOI":"10.4103\/japtr.japtr_98_21","volume":"12","author":"AN Bitar","year":"2021","unstructured":"Bitar AN, Sulaiman SAS, Ali IABH, Khan AH (2021) Prevalence, risk assessment, and predictors of osteoporosis among chronic obstructive pulmonary disease patients. J Adv Pharm Technol Res 12:395\u2013401","journal-title":"J Adv Pharm Technol Res"},{"key":"7776_CR24","doi-asserted-by":"publisher","first-page":"1456","DOI":"10.1378\/chest.08-3016","volume":"136","author":"GT Ferguson","year":"2009","unstructured":"Ferguson GT, Calverley PMA, Anderson JA, Jenkins CR, Jones PW, Willits LR, Yates JC, Vestbo J, Celli B (2009) Prevalence and progression of osteoporosis in patients with COPD: results from the TOwards a Revolution in COPD Health study. Chest 136:1456\u20131465","journal-title":"Chest"},{"key":"7776_CR25","volume":"2016","author":"M Abbasi","year":"2016","unstructured":"Abbasi M, Zohal M, Atapour B, Yazdi Z (2016) Prevalence of osteoporosis and its risk factors in men with COPD in Qazvin. Int J Chronic Dis 2016:4038530","journal-title":"Int J Chronic Dis"},{"key":"7776_CR26","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1016\/j.arbr.2018.10.013","volume":"55","author":"MR Gazzotti","year":"2019","unstructured":"Gazzotti MR, Roco CM, Pradella CO, Nascimento OA, Porto EF, Adas M, Lazaretti-Castro M, Jardim JR (2019) Frequency of osteoporosis and vertebral fractures in chronic obstructive pulmonary disease (COPD) patients. Arch Bronconeumol (Engl Ed) 55:252\u2013257","journal-title":"Arch Bronconeumol (Engl Ed)"},{"key":"7776_CR27","doi-asserted-by":"publisher","first-page":"861","DOI":"10.1016\/j.rmed.2011.12.020","volume":"106","author":"L Graat-Verboom","year":"2012","unstructured":"Graat-Verboom L, Smeenk FW, van den Borne BE, Spruit MA, Jansen FH, van Enschot JW, Wouters EF (2012) Progression of osteoporosis in patients with COPD: a 3-year follow up study. Respir Med 106:861\u2013870","journal-title":"Respir Med"},{"key":"7776_CR28","doi-asserted-by":"publisher","first-page":"564","DOI":"10.4158\/GL-2020-0524","volume":"26","author":"PM Camacho","year":"2020","unstructured":"Camacho PM, Petak SM, Binkley N et al (2020) American association of clinical endocrinologists\/american college of endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis- 2020 update. Endocr Pract 26:564\u2013570","journal-title":"Endocr Pract"},{"key":"7776_CR29","doi-asserted-by":"publisher","first-page":"724","DOI":"10.1007\/s00198-004-1600-y","volume":"15","author":"S Muraki","year":"2004","unstructured":"Muraki S, Yamamoto S, Ishibashi H, Horiuchi T, Hosoi T, Orimo H, Nakamura K (2004) Impact of degenerative spinal diseases on bone mineral density of the lumbar spine in elderly women. Osteoporos Int 15:724\u2013728","journal-title":"Osteoporos Int"},{"key":"7776_CR30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.clinthera.2004.12.020","volume":"27","author":"D Felsenberg","year":"2005","unstructured":"Felsenberg D, Boonen S (2005) The bone quality framework: determinants of bone strength and their interrelationships, and implications for osteoporosis management. Clin Ther 27:1\u201311","journal-title":"Clin Ther"},{"key":"7776_CR31","doi-asserted-by":"publisher","first-page":"2088","DOI":"10.1002\/art.42646","volume":"75","author":"MB Humphrey","year":"2023","unstructured":"Humphrey MB, Russell L, Danila MI et al (2023) 2022 American College of Rheumatology guideline for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Rheumatol 75:2088\u20132102","journal-title":"Arthritis Rheumatol"},{"key":"7776_CR32","doi-asserted-by":"publisher","first-page":"2184","DOI":"10.1001\/jama.2011.715","volume":"305","author":"AV Schwartz","year":"2011","unstructured":"Schwartz AV, Vittinghoff E, Bauer DC et al (2011) Association of BMD and FRAX score with risk of fracture in older adults with type 2 diabetes. JAMA 305:2184\u20132192","journal-title":"JAMA"},{"key":"7776_CR33","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1007\/s40520-019-01432-y","volume":"32","author":"JA Kanis","year":"2020","unstructured":"Kanis JA, Harvey NC, Johansson H, Liu E, Vandenput L, Lorentzon M, Leslie WD, McCloskey EV (2020) A decade of FRAX: how has it changed the management of osteoporosis? Aging Clin Exp Res 32:187\u2013196","journal-title":"Aging Clin Exp Res"},{"key":"7776_CR34","doi-asserted-by":"publisher","first-page":"1165","DOI":"10.1016\/j.rmed.2008.03.003","volume":"102","author":"JD Carter","year":"2008","unstructured":"Carter JD, Patel S, Sultan FL et al (2008) The recognition and treatment of vertebral fractures in males with chronic obstructive pulmonary disease. Respir Med 102:1165\u20131172","journal-title":"Respir Med"},{"key":"7776_CR35","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.jocd.2015.08.004","volume":"19","author":"JT Schousboe","year":"2016","unstructured":"Schousboe JT (2016) Epidemiology of vertebral fractures. J Clin Densitom 19:8\u201322","journal-title":"J Clin Densitom"},{"key":"7776_CR36","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1186\/s12890-023-02702-2","volume":"23","author":"Z Wang","year":"2023","unstructured":"Wang Z, Zhou X, Deng M, Yin Y, Li Y, Zhang Q, Bian Y, Miao J, Li J, Hou G (2023) Clinical impacts of sarcopenic obesity on chronic obstructive pulmonary disease: a cross-sectional study. BMC Pulm Med 23:394","journal-title":"BMC Pulm Med"},{"key":"7776_CR37","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1038\/s41574-023-00943-z","volume":"20","author":"CM Prado","year":"2024","unstructured":"Prado CM, Batsis JA, Donini LM, Gonzalez MC, Siervo M (2024) Sarcopenic obesity in older adults: a clinical overview. Nat Rev Endocrinol 20:261\u2013277","journal-title":"Nat Rev Endocrinol"},{"key":"7776_CR38","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1007\/s00774-024-01527-1","volume":"42","author":"D Inoue","year":"2024","unstructured":"Inoue D, Inoue R (2024) Mechanisms of osteoporosis associated with chronic obstructive pulmonary disease. J Bone Miner Metab 42:428\u2013437","journal-title":"J Bone Miner Metab"},{"key":"7776_CR39","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1007\/s00198-017-4314-7","volume":"29","author":"R Watanabe","year":"2018","unstructured":"Watanabe R, Tai N, Hirano J, Ban Y, Inoue D, Okazaki R (2018) Independent association of bone mineral density and trabecular bone score to vertebral fracture in male subjects with chronic obstructive pulmonary disease. Osteoporos Int 29:615\u2013623","journal-title":"Osteoporos Int"},{"key":"7776_CR40","doi-asserted-by":"publisher","first-page":"91","DOI":"10.3109\/07853890.2012.671536","volume":"45","author":"EA Romme","year":"2013","unstructured":"Romme EA, Rutten EP, Smeenk FW, Spruit MA, Menheere PP, Wouters EF (2013) Vitamin D status is associated with bone mineral density and functional exercise capacity in patients with chronic obstructive pulmonary disease. Ann Med 45:91\u201396","journal-title":"Ann Med"},{"key":"7776_CR41","doi-asserted-by":"publisher","DOI":"10.1007\/s00774-024-01527-1","author":"D Inoue","year":"2024","unstructured":"Inoue D, Inoue R (2024) Mechanisms of osteoporosis associated with chronic obstructive pulmonary disease. J Bone Miner Metab. https:\/\/doi.org\/10.1007\/s00774-024-01527-1","journal-title":"J Bone Miner Metab"},{"key":"7776_CR42","doi-asserted-by":"publisher","first-page":"574","DOI":"10.1136\/thx.2003.019588","volume":"59","author":"WQ Gan","year":"2004","unstructured":"Gan WQ, Man SF, Senthilselvan A, Sin DD (2004) Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and a meta-analysis. Thorax 59:574\u2013580","journal-title":"Thorax"},{"key":"7776_CR43","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00198-008-0643-x","volume":"20","author":"EJ Waugh","year":"2009","unstructured":"Waugh EJ, Lam MA, Hawker GA et al (2009) Risk factors for low bone mass in healthy 40\u201360 year old women: a systematic review of the literature. Osteoporos Int 20:1\u201321","journal-title":"Osteoporos Int"},{"key":"7776_CR44","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1038\/clpt.2011.105","volume":"90","author":"J Audrain-McGovern","year":"2011","unstructured":"Audrain-McGovern J, Benowitz NL (2011) Cigarette smoking, nicotine, and body weight. Clin Pharmacol Ther 90:164\u2013168","journal-title":"Clin Pharmacol Ther"},{"key":"7776_CR45","doi-asserted-by":"publisher","first-page":"1018","DOI":"10.1016\/j.chest.2016.12.006","volume":"151","author":"JA Hwang","year":"2017","unstructured":"Hwang JA, Kim YS, Leem AY, Park MS, Kim SK, Chang J, Jung JY (2017) Clinical implications of sarcopenia on decreased bone density in men with COPD. Chest 151:1018\u20131027","journal-title":"Chest"}],"container-title":["Osteoporosis International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00198-025-07776-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00198-025-07776-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00198-025-07776-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T12:03:50Z","timestamp":1769515430000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00198-025-07776-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,22]]},"references-count":45,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["7776"],"URL":"https:\/\/doi.org\/10.1007\/s00198-025-07776-8","relation":{},"ISSN":["0937-941X","1433-2965"],"issn-type":[{"value":"0937-941X","type":"print"},{"value":"1433-2965","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,22]]},"assertion":[{"value":"25 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 November 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 November 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study complies with the Declaration of Helsinki. All RA patients provided written informed consent to participate, and the research protocol was approved by the local EPM\/UNIFESP\u2019s Ethics Committee (protocol number 35234720.2.0000.5505).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Roberta Q. Graumam, Luiza V. A. Silva, Marcela M. C. Pinheiro, Vera L. Szejnfeld, and Charlles H. M. Castro have declared no conflicts of interest.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}