{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T16:51:00Z","timestamp":1792601460689,"version":"4.5.0"},"reference-count":44,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T00:00:00Z","timestamp":1751241600000},"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>Background\/Objectives: Rheumatoid arthritis (RA) is a chronic inflammatory disease frequently accompanied by comorbid conditions that contribute to disability and worsen long-term outcomes. Among these, malnutrition and osteosarcopenia remain under-recognised. This cross-sectional study aimed to assess the prevalence of malnutrition and osteosarcopenia among elderly women with RA and explore the clinical impact of these conditions. Methods: Sixty-five women over 65 years with RA were evaluated using Global Leadership Initiative on Malnutrition (GLIM) criteria for malnutrition and EWGSOP2-based assessments for sarcopenia; bone status was measured by dual-energy X-ray absorptiometry (DXA), trabecular bone score (TBS), and three-dimensional DXA (3D-DXA). Results: Malnutrition was identified in 49.2% and osteosarcopenia in 52.3% of participants. A significant bidirectional association was observed: malnourished patients had higher rates of osteosarcopenia (65.6% vs. 34.4%; p &lt; 0.05), and osteosarcopenic patients were more frequently malnourished (61.8% vs. 39.1%; p &lt; 0.05). Both conditions were associated with older age, lower body mass index (BMI), impaired muscle parameters, and reduced bone mineral density. Malnourished and osteosarcopenic patients reported worse fatigue and lower physical quality of life, despite similar inflammatory activity. Significant correlations were found between muscle mass indices and bone quality metrics assessed by 3D-DXA. These findings highlight a substantial burden of malnutrition and osteosarcopenia in elderly women with RA, even with well-controlled disease despite similar inflammatory activity (mean Disease Activity Score 28: 2.8 \u00b1 1.0; 43.1% in remission. Conclusions: There is a substantial burden of malnutrition and osteosarcopenia in elderly women with RA that support the integration of systematic nutritional and musculoskeletal screening into routine care. Future studies should evaluate age- and disease-specific mechanisms and assess the benefit of multidisciplinary strategies to prevent frailty and improve long-term outcomes.<\/jats:p>","DOI":"10.3390\/nu17132186","type":"journal-article","created":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T10:03:48Z","timestamp":1751277828000},"page":"2186","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Malnutrition and Osteosarcopenia in Elderly Women with Rheumatoid Arthritis: A Dual Clinical Perspective"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2358-6767","authenticated-orcid":false,"given":"Joan M.","family":"Nolla","sequence":"first","affiliation":[{"name":"Department of Rheumatology, IDIBELL-Hospital Universitari de Bellvitge, University of Barcelona, 08907 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Moragues","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, IDIBELL-Hospital Universitari de Bellvitge, University of Barcelona, 08907 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lidia","family":"Valencia-Muntal\u00e0","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, IDIBELL-Hospital Universitari de Bellvitge, University of Barcelona, 08907 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8181-4637","authenticated-orcid":false,"given":"Laia","family":"de Daniel-Bisbe","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, IDIBELL-Hospital Universitari de Bellvitge, University of Barcelona, 08907 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3373-7503","authenticated-orcid":false,"given":"Laura","family":"Berbel-Arcob\u00e9","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, IDIBELL-Hospital Universitari de Bellvitge, University of Barcelona, 08907 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego","family":"Benavent","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, IDIBELL-Hospital Universitari de Bellvitge, University of Barcelona, 08907 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Vidal-Montal","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, IDIBELL-Hospital Universitari de Bellvitge, University of Barcelona, 08907 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoni","family":"Rozadilla","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, IDIBELL-Hospital Universitari de Bellvitge, University of Barcelona, 08907 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1614-8064","authenticated-orcid":false,"given":"Javier","family":"Narv\u00e1ez","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, IDIBELL-Hospital Universitari de Bellvitge, University of Barcelona, 08907 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"G\u00f3mez-Vaquero","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, IDIBELL-Hospital Universitari de Bellvitge, University of Barcelona, 08907 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2019","DOI":"10.1016\/S0140-6736(23)01525-8","article-title":"Rheumatoid arthritis","volume":"402","author":"Bathon","year":"2023","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"152249","DOI":"10.1016\/j.semarthrit.2023.152249","article-title":"Comparative effectiveness of treatments for rheumatoid arthritis in clinical practice: A systematic review","volume":"62","author":"Sparks","year":"2023","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2906","DOI":"10.1093\/rheumatology\/keaa737","article-title":"Cardiovascular mortality and cardiovascular event rates in patients with inflammatory rheumatic diseases in the CARdiovascular in rheuMAtology (CARMA) prospective study-results at 5 years of follow-up","volume":"60","year":"2021","journal-title":"Rheumatology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"116654","DOI":"10.1016\/j.bone.2022.116654","article-title":"High incidence of clinical fragility fractures in postmenopausal women with rheumatoid arthritis. A case-control study","volume":"168","author":"Olmos","year":"2023","journal-title":"Bone"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"rkaf017","DOI":"10.1093\/rap\/rkaf017","article-title":"Longitudinal risk of serious infections in patients with inflammatory arthritis on immunomodulating therapy compared to controls","volume":"9","author":"Christensen","year":"2025","journal-title":"Rheumatol. Adv. Pract."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"45","DOI":"10.2147\/OARRR.S298393","article-title":"Beyond rheumatoid arthritis evaluation: What are we missing?","volume":"13","author":"Espinoza","year":"2021","journal-title":"Open Access Rheumatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1927","DOI":"10.1016\/S0140-6736(21)01451-3","article-title":"Management of disease-related malnutrition for patients being treated in hospital","volume":"398","author":"Schuetz","year":"2021","journal-title":"Lancet"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Olsen, M.N., Tangvik, R.J., and Halse, A.K. (2020). Evaluation of nutritional status and methods to identify nutritional risk in rheumatoid arthritis and spondyloarthritis. Nutrients, 12.","DOI":"10.3390\/nu12113571"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.clnu.2018.08.002","article-title":"GLIM criteria for the diagnosis of malnutrition\u2014A consensus report from the global clinical nutrition community","volume":"38","author":"Cederholm","year":"2019","journal-title":"Clin. Nutr."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Bellanti, F., Lo Buglio, A., Quiete, S., Pellegrino, G., Dobrakowski, M., Kasperczyk, A., Kasperczyk, S., and Vendemiale, G. (2020). Comparison of three nutritional screening tools with the new GLIM criteria for malnutrition and association with sarcopenia in hospitalized older patients. J. Clin. Med., 9.","DOI":"10.3390\/jcm9061898"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Nishioka, S., Matsushita, T., Yamanouchi, A., Okazaki, Y., Oishi, K., Nishioka, E., Mori, N., Tokunaga, Y., and Onizuka, S. (2021). Prevalence and associated factors of coexistence of malnutrition and sarcopenia in geriatric rehabilitation. Nutrients, 13.","DOI":"10.3390\/nu13113745"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2636","DOI":"10.1016\/S0140-6736(19)31138-9","article-title":"Sarcopenia","volume":"393","author":"Sayer","year":"2019","journal-title":"Lancet"},{"key":"ref_13","first-page":"16","article-title":"Sarcopenia: Revised European consensus on definition and diagnosis","volume":"4","author":"Bahat","year":"2019","journal-title":"Age Ageing"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"S153","DOI":"10.1097\/RHU.0000000000001549","article-title":"Prevalence of sarcopenia and whole-body composition in rheumatoid arthritis","volume":"27","author":"Brance","year":"2021","journal-title":"J. Clin. Rheumatol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Cano-Garc\u00eda, L., Manrique-Arija, S., Dom\u00ednguez-Quesada, C., Vacas-P\u00e9rez, J.C., Armenteros-Ortiz, P.J., Ruiz-Vilchez, D., and Carmona, L. (2023). Sarcopenia and nutrition in elderly rheumatoid arthritis patients: A cross-sectional study to determine prevalence and risk factors. Nutrients, 15.","DOI":"10.3390\/nu15112440"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Valencia-Muntal\u00e0, L., G\u00f3mez-Vaquero, C., Mora, M., Berbel-Arcob\u00e9, L., Benavent, D., Narv\u00e1ez, J., Rozadilla, A., and Nolla, J.M. (2024). Evaluating sarcopenia prevalence and SARC-F effectiveness in elderly Spanish women with RA: A comparative study of EWGSOP criteria. Front. Med., 11.","DOI":"10.3389\/fmed.2024.1392604"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/j.jocd.2009.06.004","article-title":"Beyond FRAX: It\u2019s time to consider \u201csarco-osteopenia\u201d","volume":"12","author":"Binkley","year":"2009","journal-title":"J. Clin. Densitom."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2781","DOI":"10.1007\/s00198-017-4151-8","article-title":"Osteosarcopenia: Where bone, muscle, and fat collide","volume":"28","author":"Hirschfeld","year":"2017","journal-title":"Osteoporos. Int."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1002\/jcsm.12870","article-title":"Associations of osteoporosis and sarcopenia with frailty and multimorbidity among participants of the Hertfordshire Cohort Study","volume":"13","author":"Laskou","year":"2022","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1007\/s00223-023-01181-1","article-title":"Osteosarcopenia: Prevalence and 10-year fracture and mortality risk\u2014A longitudinal, population-based study of 75-year-old women","volume":"114","author":"Paulin","year":"2024","journal-title":"Calcif Tissue Int."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/j.jamda.2019.09.005","article-title":"The joint occurrence of osteoporosis and sarcopenia (osteosarcopenia): Definitions and characteristics","volume":"21","author":"Phu","year":"2020","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1016\/j.jamda.2014.10.018","article-title":"Phenotype of osteosarcopenia in older individuals with a history of falling","volume":"16","author":"Huo","year":"2015","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1016\/j.afos.2021.11.002","article-title":"Osteosarcopenia synergistically increases the risk of falls in patients with rheumatoid arthritis","volume":"7","author":"Tada","year":"2021","journal-title":"Osteoporos Sarcopenia"},{"key":"ref_24","first-page":"1987","article-title":"Disease activity score 28 as an instrument to measure disease activity in patients with early rheumatoid arthritis","volume":"34","author":"Kautiainen","year":"2007","journal-title":"J. Rheumatol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1093\/rheumatology\/kem364","article-title":"An index of only patient-reported outcome measures, Routine Assessment of Patient Index Data 3 (RAPID3), in two abatacept clinical trials: Similar results to disease activity score (DAS28) and other RAPID indices that include physician-reported measures","volume":"47","author":"Pincus","year":"2008","journal-title":"Rheumatology"},{"key":"ref_26","first-page":"2116","article-title":"Spanish version of the health assessment questionnaire: Reliability, validity, and transcultural equivalency","volume":"20","author":"Reig","year":"1993","journal-title":"J. Rheumatol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1186\/1477-7525-1-79","article-title":"The Functional Assessment of Chronic Illness Therapy (FACIT) Measurement System: Properties, applications, and interpretation","volume":"1","author":"Webster","year":"2003","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1097\/00005650-199603000-00003","article-title":"A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity","volume":"34","author":"Ware","year":"1996","journal-title":"Med. Care"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/j.jamda.2013.05.018","article-title":"SARC-F: A simple questionnaire to rapidly diagnose sarcopenia","volume":"14","author":"Malmstrom","year":"2013","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1007\/BF01623462","article-title":"Study of bone mineral density in lumbar spine and femoral neck in a Spanish population: Multicentre Research Project on Osteoporosis","volume":"7","author":"Rapado","year":"1997","journal-title":"Osteoporos. Int."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1007\/s001980050093","article-title":"Updated data on proximal femur bone mineral levels of US adults","volume":"8","author":"Looker","year":"1998","journal-title":"Osteoporos. Int."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/j.jocd.2019.07.001","article-title":"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","volume":"22","author":"Shuhart","year":"2019","journal-title":"J. Clin. Densitom."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.jocd.2008.11.006","article-title":"Evaluation of the potential use of trabecular bone score to complement bone mineral density in the diagnosis of osteoporosis: A preliminary spine BMD\u2013matched, case-control study","volume":"12","author":"Pothuaud","year":"2009","journal-title":"J. Clin. Densitom."},{"key":"ref_34","first-page":"148","article-title":"Age-related reference data for cortical and trabecular 3D-DXA parameters: The SEIOMM-3D-DXA Project","volume":"39","author":"Casado","year":"2024","journal-title":"J. Bone Miner. Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1007\/s00520-024-08324-6","article-title":"Malnutrition prevalence in cancer patients in Belgium: The ONCOCARE study","volume":"32","author":"Rasschaert","year":"2024","journal-title":"Support. Care Cancer"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1007\/s00394-023-03323-5","article-title":"Malnutrition prevalence according to GLIM and its feasibility in geriatric patients: A prospective cross-sectional study","volume":"63","author":"Enge","year":"2024","journal-title":"Eur. J. Nutr."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1108","DOI":"10.1001\/archinte.164.10.1108","article-title":"Bone mineral density thresholds for pharmacological intervention to prevent fractures","volume":"164","author":"Siris","year":"2004","journal-title":"Arch. Intern. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1038\/s41584-024-01120-w","article-title":"Osteoporosis and fracture risk are multifactorial in patients with inflammatory rheumatic diseases","volume":"20","author":"Buttgereit","year":"2024","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1016\/j.semarthrit.2020.10.002","article-title":"The prevalence and risk factors of sarcopenia in rheumatoid arthritis patients: A systematic review and meta-regression analysis","volume":"5","author":"Li","year":"2021","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"ii27","DOI":"10.1093\/ageing\/afl081","article-title":"The role of cortical bone and its microstructure in bone strength","volume":"35","author":"Augat","year":"2006","journal-title":"Age Ageing"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Zhang, J., Wang, X., Fang, J., Li, Y., Yu, Y., Wang, J., and Sun, B. (2025). Contributions of dietary patterns and factors to regulation of rheumatoid disease. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26062674"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1953","DOI":"10.1016\/j.jamda.2020.09.029","article-title":"Malnutrition According to GLIM Criteria and Adverse Outcomes in Community-Dwelling Chinese Older Adults: A Prospective Analysis","volume":"22","author":"Yeung","year":"2021","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"234","DOI":"10.4274\/MMJ.galenos.2022.14377","article-title":"Prevalence of Malnutrition According to the Global Leadership Initiative on Malnutrition Criteria in Community-dwelling Older Adults in Turkey","volume":"37","author":"Demirdag","year":"2022","journal-title":"Medeni. Med. J."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Lengel\u00e9, L., Bruy\u00e8re, O., Beaudart, C., Reginster, J.Y., and Locquet, M. (2021). Impact of Malnutrition Status on Muscle Parameter Changes over a 5-Year Follow-Up of Community-Dwelling Older Adults from the SarcoPhAge Cohort. Nutrients, 13.","DOI":"10.3390\/nu13020407"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/13\/2186\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:02:06Z","timestamp":1760032926000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/13\/2186"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,30]]},"references-count":44,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["nu17132186"],"URL":"https:\/\/doi.org\/10.3390\/nu17132186","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,30]]}}}