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19-12-2019 | Systemic sclerosis | News

Meta-analysis indicates need for BMD monitoring in SSc patients

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medwireNews: Individuals with systemic sclerosis (SSc) have lower bone mineral density (BMD) and a higher risk for vertebral fracture than those without the disease, indicate findings from a meta-analysis.

Therefore, “[t]he early monitoring of BMD in patients with SSc is recommended for the prevention of osteoporosis and fracture,” say Ling Lei (The First Affiliated Hospital of Guangxi Medical University, Nanning, China) and co-authors.

The meta-analysis included 18 studies comprising a total of 2580 patients with SSc and 11,550 controls. The majority (92%) of study participants were female and over three-quarters of these women were postmenopausal.

As reported in Clinical Rheumatology, patients with SSc had significantly lower whole-body BMD than controls, with a pooled weighted mean difference (WMD) of 0.07. Similarly, BMD at the femoral neck, hip, and femoral trochanter was significantly lower in patients with SSc compared with controls (WMD=0.28, 0.10, and 0.06, respectively).

Lei and colleagues note that average lumbar spine BMD was not significantly lower among SSc patients versus controls in the overall analysis of 16 studies evaluating this outcome, but the association reached statistical significance after the exclusion of a study found to have a high degree of heterogeneity (WMD=0.08).

“[The excluded] study mainly included subjects from Africa, whereas the majority of the studies included populations from Europe, the USA, and Asia,” and “[t]here was a possibility that ethnic differences may have been a major contributing factor with regard to study outcome,” they explain.

When the different subtypes of SSc were analyzed separately, patients with diffuse cutaneous SSc had significantly lower BMD at the lumbar spine than those with limited cutaneous disease (WMD=0.09).

The team also found that the presence of SSc was associated with a significantly elevated risk for vertebral fracture, with a pooled odds ratio of 10.38. There was a trend toward elevated risk for osteoporotic fracture among patients with versus without SSc, but the association did not reach statistical significance.

Lai and coworkers say that “[t]he specific pathogenic mechanism underlying bone mass reduction in SSc remains unclear,” but speculate that risk factors such as compromised mineral absorption, corticosteroid use, and insufficient vitamin D levels due to limited sunlight exposure may play a role.

By Claire Barnard

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

Clin Rheumatol 2019; doi:10.1007/s10067-019-04847-0

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