{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T13:22:27Z","timestamp":1788009747479,"version":"build-2784847793"},"reference-count":44,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2018,2,18]],"date-time":"2018-02-18T00:00:00Z","timestamp":1518912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Treatment of rheumatoid arthritis (RA) with biological disease-modifying anti-rheumatic drugs (bDMARDs) induces rapid remission. However, osteoporosis and its management remains a problem. The Geriatric Nutritional Risk Index (GNRI) evaluates the risk of malnutrition-related complications in elderly patients and has been shown to be a significant predictor of many diseases. We evaluated the correlation between GNRI and RA activity. In addition, risk factors for femoral neck bone loss were evaluated in RA patients treated with bDMARDs. We retrospectively examined the medical records of 146 patients with RA, collecting and recording the patients\u2019 demographic and clinical characteristics. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry. Inverse correlations were observed between GNRI and disease duration, disease activity score-28 joint count serum C-reactive protein (CRP), simple disease activity index, modified health assessment questionnaire score and CRP. GNRI showed correlation with femoral neck BMD and femoral neck BMD \u2264 70% of young adult men (YAM). Multiple regression analysis showed that female sex, increased age and lower GNRI were risk factors for lower BMD of the femoral neck. Multivariate binomial logistic regression analysis showed that female sex (odd ratio: 3.67) and lower GNRI (odd ratio: 0.87) were risk factors for BMD \u2264 70% of YAM. Because the GNRI is a simple method, it might be a simple predictor for RA activity and BMD status in RA patients. Complementary nutritional therapies might improve RA activity and osteoporosis in RA patients who have undergone treatment with bDMARDs.<\/jats:p>","DOI":"10.3390\/nu10020234","type":"journal-article","created":{"date-parts":[[2018,2,20]],"date-time":"2018-02-20T03:54:22Z","timestamp":1519098862000},"page":"234","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Association between Bone Mineral Density of Femoral Neck and Geriatric Nutritional Risk Index in Rheumatoid Arthritis Patients Treated with Biological Disease-Modifying Anti-Rheumatic Drugs"],"prefix":"10.3390","volume":"10","author":[{"given":"Hiroto","family":"Tokumoto","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan"},{"name":"Department of Orthopaedic Surgery, Japanese Red Cross Kagoshima Hospital, Kagoshima 891-0133, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Tominaga","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiya","family":"Arishima","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Go","family":"Jokoji","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan"},{"name":"Department of Orthopaedic Surgery, Japanese Red Cross Kagoshima Hospital, Kagoshima 891-0133, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaki","family":"Akimoto","sequence":"additional","affiliation":[{"name":"Department of Hematology and Immunology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideo","family":"Ohtsubo","sequence":"additional","affiliation":[{"name":"Center for Rheumatic Diseases, Japanese Red Cross Kagoshima Hospital, Kagoshima 891-0133, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eiji","family":"Taketomi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Japanese Red Cross Kagoshima Hospital, Kagoshima 891-0133, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuhiko","family":"Sunahara","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan"},{"name":"Department of Orthopaedic Surgery, Japanese Red Cross Kagoshima Hospital, Kagoshima 891-0133, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Nagano","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuhiro","family":"Ishidou","sequence":"additional","affiliation":[{"name":"Department of Medical Joint Materials, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Setsuro","family":"Komiya","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takao","family":"Setoguchi","sequence":"additional","affiliation":[{"name":"The Near-Future Locomotor Organ Medicine Creation Course (Kusunoki Kai), Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2018,2,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s10067-010-1634-9","article-title":"The burden of illness of rheumatoid arthritis","volume":"30","author":"Boonen","year":"2011","journal-title":"Clin. Rheumatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s40744-015-0021-z","article-title":"Biologics prescribing for rheumatoid arthritis in older patients: A single-center retrospective cross-sectional study","volume":"2","author":"Morsley","year":"2015","journal-title":"Rheumatol. Ther."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1136\/annrheumdis-2012-201319","article-title":"Impact of tumour necrosis factor inhibitor treatment on radiographic progression in rheumatoid arthritis patients in clinical practice: Results from the nationwide Danish DANBIO registry","volume":"72","author":"Ornbjerg","year":"2013","journal-title":"Ann. Rheum. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1093\/rheumatology\/ker332","article-title":"The incidence of permanent work disability in patients with rheumatoid arthritis in Sweden 1990\u20132010: Before and after introduction of biologic agents","volume":"51","author":"Hallert","year":"2012","journal-title":"Rheumatology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/j.berh.2011.10.009","article-title":"Co-morbidities in established rheumatoid arthritis","volume":"25","author":"Gullick","year":"2011","journal-title":"Best Pract. Res. Clin. Rheumatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1093\/ajcn\/74.1.6","article-title":"Treatment of protein-energy malnutrition in chronic nonmalignant disorders","volume":"74","author":"Akner","year":"2001","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1046\/j.1365-277X.2003.00423.x","article-title":"Nutritional management of rheumatoid arthritis: A review of the evidence","volume":"16","author":"Rennie","year":"2003","journal-title":"J. Hum. Nutr. Diet"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1080\/07315724.2014.945197","article-title":"Poor socioeconomic and nutritional status are associated with osteoporosis in Korean postmenopausal women: Data from the Fourth Korea National Health and Nutrition Examination Survey (KNHANES) 2009","volume":"34","author":"Kim","year":"2015","journal-title":"J. Am. Coll. Nutr."},{"key":"ref_9","first-page":"599","article-title":"Nutrition and bone health in women after the menopause","volume":"10","author":"Rizzoli","year":"2014","journal-title":"Women\u2019s Health"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1093\/ajcn\/87.1.150","article-title":"Dietary protein intake is associated with lean mass change in older, community-dwelling adults: The Health, Aging and Body Composition (health ABC) Study","volume":"87","author":"Houston","year":"2008","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1111\/j.1753-4887.2010.00321.x","article-title":"Effect of protein intake on bone and muscle mass in the elderly","volume":"68","author":"Martini","year":"2010","journal-title":"Nutr. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1007\/s11845-017-1642-8","article-title":"The relationship between protein quantity, BMD and fractures in older adults","volume":"187","author":"Curneen","year":"2018","journal-title":"Ir. J. Med. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1016\/j.beem.2008.08.005","article-title":"Nutrition: Its role in bone health","volume":"22","author":"Rizzoli","year":"2008","journal-title":"Best Pract. Res. Clin. Endocrinol. Metabol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1016\/j.bone.2009.10.005","article-title":"Maximizing bone mineral mass gain during growth for the prevention of fractures in the adolescents and the elderly","volume":"46","author":"Rizzoli","year":"2010","journal-title":"Bone"},{"key":"ref_15","first-page":"6","article-title":"The geriatric nutritional risk index may predict healthcare costs and health transitions during hemodialysis in china","volume":"26","author":"Dou","year":"2017","journal-title":"Asia Pac. J. Clin. Nutr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"405","DOI":"10.3747\/pdi.2012.00018","article-title":"Geriatric nutritional risk index as a prognostic factor in peritoneal dialysis patients","volume":"33","author":"Kang","year":"2013","journal-title":"Perit. Dial. Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1053\/j.jrn.2009.04.004","article-title":"Geriatric nutritional risk index as a screening tool for malnutrition in patients on chronic peritoneal dialysis","volume":"20","author":"Szeto","year":"2010","journal-title":"J. Ren. Nutr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1740","DOI":"10.1016\/j.amjcard.2017.02.051","article-title":"Prognostic impact of the geriatric nutritional risk index on long-term outcomes in patients who underwent percutaneous coronary intervention","volume":"119","author":"Wada","year":"2017","journal-title":"Am. J. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/j.numecd.2017.02.003","article-title":"Geriatric nutritional risk index as a nutritional and survival risk assessment tool in stable outpatients with systolic heart failure","volume":"27","author":"Sargento","year":"2017","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1617","DOI":"10.1111\/ggi.12942","article-title":"Relationship between functional independence measure and geriatric nutritional risk index in pneumonia patients in long-term nursing care facilities","volume":"17","author":"Mitani","year":"2017","journal-title":"Geriatr. Gerontol. Int."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"5797194","DOI":"10.1155\/2017\/5797194","article-title":"The geriatric nutritional risk index independently predicts mortality in diabetic foot ulcers patients undergoing amputations","volume":"2017","author":"Xie","year":"2017","journal-title":"J. Diabetes. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1111\/ggi.12828","article-title":"Correlations between geriatric nutritional risk index and peripheral artery disease in elderly coronary artery disease patients","volume":"17","author":"Kawamiya","year":"2017","journal-title":"Geriatr. Gerontol. Int."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1016\/j.amjcard.2016.05.045","article-title":"Usefulness of geriatric nutritional risk index for assessing nutritional status and its prognostic impact in patients aged \u2265 65 years with acute heart failure","volume":"118","author":"Honda","year":"2016","journal-title":"Am. J. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Bo, Y., Wang, K., Liu, Y., You, J., Cui, H., Zhu, Y., Lu, Q., and Yuan, L. (2016). The geriatric nutritional risk index predicts survival in elderly esophageal squamous cell carcinoma patients with radiotherapy. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0155903"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1016\/j.hrtlng.2015.08.004","article-title":"Comparison of geriatric nutritional risk index scores on physical performance among elderly patients with chronic obstructive pulmonary disease","volume":"44","author":"Matsumura","year":"2015","journal-title":"Heart Lung"},{"key":"ref_26","first-page":"323","article-title":"Diagnostic criteria for primary osteoporosis: Year 2012 revision","volume":"24","author":"Soen","year":"2014","journal-title":"Clin. Calcium"},{"key":"ref_27","first-page":"11","article-title":"Revised osteoporosis diagnostic criteria and Japanese practice guideline on osteoporosis","volume":"24","author":"Hagino","year":"2014","journal-title":"Clin. Calcium"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1007\/s00774-013-0447-8","article-title":"Diagnostic criteria for primary osteoporosis: Year 2012 revision","volume":"31","author":"Soen","year":"2013","journal-title":"J. Bone Miner. Metab."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1002\/jbmr.5650090802","article-title":"The diagnosis of osteoporosis","volume":"9","author":"Kanis","year":"1994","journal-title":"J. Bone Miner. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1177\/0115426506021003312","article-title":"Comparison of ideal body weight equations and published height-weight tables with body mass index tables for healthy adults in the united states","volume":"21","author":"Shah","year":"2006","journal-title":"Nutr. Clin. Pract."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1252","DOI":"10.1093\/rheumatology\/keh297","article-title":"Remission in rheumatoid arthritis: Agreement of the disease activity score (DAS28) with the ARA preliminary remission criteria","volume":"43","author":"Fransen","year":"2004","journal-title":"Rheumatology"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1079\/PNS19980036","article-title":"The role of nutrition and diet in rheumatoid arthritis","volume":"57","author":"Martin","year":"1998","journal-title":"Proc. Nutr. Soc."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1006\/pmed.2002.1015","article-title":"Female patients tend to alter their diet following the diagnosis of rheumatoid arthritis and breast cancer","volume":"34","author":"Salminen","year":"2002","journal-title":"Prev. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1016\/S1297-319X(01)00296-2","article-title":"Nutritional status in patients with rheumatoid arthritis","volume":"68","author":"Nolla","year":"2001","journal-title":"Joint Bone Spine"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1672","DOI":"10.2174\/1381612821666150130121229","article-title":"Treating COPD in older and oldest old patients","volume":"21","author":"Corsonello","year":"2015","journal-title":"Curr. Pharm. Des."},{"key":"ref_36","first-page":"1057","article-title":"Bone and nutrition. Nutrition care of renal osteodystrophy","volume":"25","author":"Tanaka","year":"2015","journal-title":"Clin. Calcium"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.1136\/gutjnl-2017-313884","article-title":"Non-alcoholic fatty liver disease and its relationship with cardiovascular disease and other extrahepatic diseases","volume":"66","author":"Adams","year":"2017","journal-title":"Gut"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"O\u2019Keefe, J.H., Bergman, N., Carrera-Bastos, P., Fontes-Villalba, M., DiNicolantonio, J.J., and Cordain, L. (2016). Nutritional strategies for skeletal and cardiovascular health: Hard bones, soft arteries, rather than vice versa. Open Heart, 3.","DOI":"10.1136\/openhrt-2015-000325"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1359\/JBMR.040208","article-title":"Dietary protein intake and risk of osteoporotic hip fracture in elderly residents of Utah","volume":"19","author":"Wengreen","year":"2004","journal-title":"J. Bone Miner. Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1093\/ajcn\/69.1.147","article-title":"Prospective study of dietary protein intake and risk of hip fracture in postmenopausal women","volume":"69","author":"Munger","year":"1999","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1007\/s00198-010-1179-4","article-title":"Does dietary protein reduce hip fracture risk in elders? The Framingham osteoporosis study","volume":"22","author":"Misra","year":"2011","journal-title":"Osteoporos Int."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1093\/ajcn\/84.1.18","article-title":"Estimation of optimal serum concentrations of 25-hydroxyvitamin d for multiple health outcomes","volume":"84","author":"Giovannucci","year":"2006","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"3215","DOI":"10.1210\/jc.2004-2364","article-title":"Prevalence of vitamin D inadequacy among postmenopausal north American women receiving osteoporosis therapy","volume":"90","author":"Holick","year":"2005","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1177\/2042018812471070","article-title":"Vitamin D and rheumatoid arthritis","volume":"3","author":"Athanassiou","year":"2012","journal-title":"Ther. Adv. Endocrinol. Metab."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/10\/2\/234\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T14:55:33Z","timestamp":1760194533000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/10\/2\/234"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,2,18]]},"references-count":44,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2018,2]]}},"alternative-id":["nu10020234"],"URL":"https:\/\/doi.org\/10.3390\/nu10020234","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,2,18]]}}}