Abstract
This study aimed at comparing the FRAX® 10-year fracture risk between SLE patients and demographically- and anthropometrically matched healthy individuals. Consecutive SLE patients aged ≥40 were analyzed for the FRAX® 10-year probability of major osteoporotic and hip fractures and their risk was compared with healthy controls matched for age, gender and body mass index. Potential determinants associated with higher 10-year fracture probability in the SLE patients were studied by regression models. Ninety subjects (45 SLE patients and 45 healthy controls) were studied. While the bone mineral density (BMD) of the lumbar spine and dominant hip was comparable between the two groups, the FRAX® 10-year probability of major and hip fractures was significantly higher in SLE patients. Significantly more SLE patients had high 10-year fracture risk as defined by the National Osteoporosis Foundation compared with healthy controls (16 vs. 2 %, p = 0.026). After controlling for glucocorticoid use and premature menopause which were significant univariate risk factors, the difference in the 10-year fracture risk became insignificant. Amongst SLE patients, increasing age, lower hip BMD and cumulative glucocorticoid dose independently predicted higher 10-year major fracture risk while higher anti-dsDNA level independently predicted higher hip fracture risk in addition to age and lower hip BMD. Chronic glucocorticoid use and premature menopause led to higher 10-year probability of major osteoporotic and hip fractures in SLE patients compared with their healthy counterparts although their BMD was comparable. Advanced age, lower hip BMD, cumulative glucocorticoid and higher anti-dsDNA level independently predicted higher 10-year fracture risk amongst SLE patients.
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Gordon C (2002) Long-term complications of systemic lupus erythematosus. Rheumatology 41:1095–1100
Panopalis P, Yazdany J (2009) Bone health in systemic lupus erythematosus. Curr Rheumatol Rep 11:177–184
García-Carrasco M, Mendoza-Pinto C, Escárcega RO et al (2009) Osteoporosis in patients with systemic lupus erythematosus. Isr Med Assoc J 11:486–491
Mok CC, Ying SK, To CH, Ma KM (2008) Bone mineral density and body composition in men with systemic lupus erythematosus: a case control study. Bone 43:327–331
Regio P, Bonfá E, Takayama L, Pereira R (2008) The influence of lean mass in trabecular and cortical bone in juvenile onset systemic lupus erythematosus. Lupus 17:787–792
Rhew EY, Lee C, Eksarko P et al (2008) Homocysteine, bone mineral density, and fracture risk over 2 years of followup in women with and without systemic lupus erythematosus. J Rheumatol 35:230–236
Weiss RJ, Wick MC, Ackermann PW, Montgomery SM (2010) Increased fracture risk in patients with rheumatic disorders and other inflammatory diseases—a case-control study with 53,108 patients with fracture. J Rheumatol 37:2247–2250
Visser K, Goekoop-Ruiterman YP, de Vries-Bouwstra JK et al (2010) A matrix risk model for the prediction of rapid radiographic progression in patients with rheumatoid arthritis receiving different dynamic treatment strategies: post hoc analyses from the BeSt study. Ann Rheum Dis 69:1333–1337
De Visser CL, Bilo HJ, Thomsen TF, Groenier KH, Meyboom-de Jong B (2003) Prediction of coronary heart disease: a comparison between the Copenhagen risk score and the Framingham risk score applied to a Dutch population. J Intern Med 253:553–562
Marshall D, Johnell O, Wedel H (1996) Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 312:1254–1259
Schwartz HA (1997) Measurement of bone density: comment on the American College of Rheumatology recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Rheum 40:1551
Borba VZ, Matos PG, da Silva Viana PR, Fernandes A, Sato EI, Lazaretti-Castro M (2005) High prevalence of vertebral deformity in premenopausal systemic lupus erythematosus patients. Lupus 14:529–533
Lee C, Almagor O, Dunlop DD, Manzi S, Spies S, Ramsey-Goldman R (2007) Self-reported fractures and associated factors in women with systemic lupus erythematosus. J Rheumatol 34:2018–2023
Li EK, Tam LS, Griffith JF et al (2009) High prevalence of asymptomatic vertebral fractures in Chinese women with systemic lupus erythematosus. J Rheumatol 36:1646–1652
Kanis JA (2002) Diagnosis of osteoporosis and assessment of fracture risk. Lancet 359:1929–1936
Cauley JA, Wu L, Wampler NS et al (2007) Clinical risk factors for fractures in multi-ethnic women: the Women’s Health Initiative. J Bone Miner Res 22:1816–1826
Van den Bergh JP, van Geel TA, Lems WF, Geusens PP (2010) Assessment of individual fracture risk: FRAX and beyond. Curr Osteoporos Rep 8:131–137
Sandhu SK, Nguyen ND, Center JR, Pocock NA, Eisman JA, Nguyen TV (2010) Prognosis of fracture: evaluation of predictive accuracy of the FRAX algorithm and Garvan nomogram. Osteoporos Int 21:863–871
FRAX® tool. http://www.shef.ac.uk/FRAX. Assessed 9 Sept 2011
Donaldson MG, Cawthon PM, Lui LY et al (2009) Study of osteoporotic fractures: Estimates of the proportion of older white women who would be recommended for pharmacologic treatment by the new U.S. National Osteoporosis Foundation Guidelines. J Bone Miner Res 24:675–680
Gladman DD, Goldsmith CH, Urowitz MB et al (1994) Sensitivity to change of 3 systemic lupus erythematosus disease activity Indices: international validation. J Rheumatol 21:1468–1471
Gladman D, Ginzler E, Goldsmith C et al (1996) The development and initial validation of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index for systemic lupus erythematosus. Arthritis Rheum 39:363–369
Dawson-Hughes B (2008) A revised clinician’s guide to the prevention and treatment of osteoporosis. J Clin Endocrinol Metab 93:2463–2465
Alele JD, Kamen DL (2010) The importance of inflammation and vitamin D status in SLE-associated osteoporosis. Autoimmun Rev 9:137–139
Li EK, Zhu TY, Tam LS et al (2010) Bone microarchitecture assessment by high-resolution peripheral quantitative computed tomography in patients with systemic lupus erythematosus taking corticosteroids. J Rheumatol 37:1473–1479
Lane NE (2006) Therapy Insight: osteoporosis and osteonecrosis in systemic lupus erythematosus. Nat Clin Pract Rheumatol 2:562–569
Kipen Y, Briganti EM, Strauss BJ, Littlejohn GO, Morand EF (1999) Three year follow-up of body composition changes in pre-menopausal women with systemic lupus erythematosus. Rheumatology 38:59–65
Bultink IE, Lems WF, Kostense PJ, Dijkmans BA, Voskuyl AE (2005) Prevalence of and risk factors for low bone mineral density and vertebral fractures in patients with systemic lupus erythematosus. Arthritis Rheum 52:2044–2050
Yee CS, Crabtree N, Skan J et al (2005) Prevalence and predictors of fragility fractures in systemic lupus erythematosus. Ann Rheum Dis 6:111–113
Lacativa PG, Farias ML (2010) Osteoporosis and inflammation. Arq Bras Endocrinol Metabol 54:123–132
Ismail AA, Cooper C, Felsenberg D et al (1999) Number and type of vertebral deformities: epidemiological characteristics and relation to back pain and height loss. European Vertebral Osteoporosis Study Group. Osteoporos Int 9:206–213
Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148
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This study is funded by the Yong Loo Lin School of Medicine, National University of Singapore and the Singapore Heart Foundation.
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Jia Qing Lim and Yang Liu have contributed equally.
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Mak, A., Lim, J.Q., Liu, Y. et al. Significantly higher estimated 10-year probability of fracture in lupus patients with bone mineral density comparable to that of healthy individuals. Rheumatol Int 33, 299–307 (2013). https://doi.org/10.1007/s00296-012-2389-1
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DOI: https://doi.org/10.1007/s00296-012-2389-1