Department of Genetic Oncology and Clinical Medicine (GenOMeC) PhD, University of Siena, Siena, Italy; Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Rheumatology Unit, Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy.
Lupus Sci Med. 2016 Jan 19;3(1):e000098. doi: 10.1136/lupus-2015-000098. eCollection 2016.
Osteoporosis (OP) and fragility fractures (FFx) are a known comorbidity in patients with systemic lupus erythematosus (SLE). This work aimed at evaluating (1) the prevalence of OP and FFx in a cohort of SLE and (2) the risk factors associated with both OP and FFx. The following data were collected from clinical charts: age, sex, menopausal status (MP), body mass index, smoking habits, disease duration, daily dose and cumulative glucocorticoids (GCs), type of organ involvement, comorbidities and medications. Data on bone metabolism, calcium and vitamin D supplementation and treatment with bisphosphonates, teriparatide or denosumab were collected, together with bone mineral density (BMD) values (measured by dual-energy X-ray absorptiometry (DXA)) and history of FFx (occurred after the onset of SLE and unrelated to trauma). OP and reduced BMD were defined according to the WHO. 186 patients were included (women 175, men 11; mean age 46.4±13 years, mean disease duration 14.9±9 years). At their last visit, 97 patients (52.2%) had a reduced BMD and 52 (27.9%) had OP. 22 patients (11.8%), all women, had at least one FFx; six patients (27.3%) were pre-menopausal. On univariate analysis, age, cumulative dose of GC, MP, therapy with antiepileptics and chronic renal failure (CRF) were correlated with OP (p<0.03); age, total amount of GC, MP, CRF, anticoagulants (AC) and antiepileptic therapy were correlated with FFx (p<0.05). The multivariate logistic model confirmed a direct association of OP and age, MP and antiepileptic therapy (p≤0.01) and of FFx and age, chronic therapy with AC and antiepileptics (p<0.03). In conclusion, low BMD is frequently observed in SLE, and FFx are observed also in premenopausal patients. Together with traditional risk factors (age, MP and GC), CRF and chronic treatments with AC or antiepileptics seem to be associated with a higher risk profile for OP and FFx occurrence.
骨质疏松症（OP）和脆性骨折（FFx）是系统性红斑狼疮（SLE）患者的已知合并症。本研究旨在评估：（1）SLE 患者中 OP 和 FFx 的患病率；（2）与 OP 和 FFx 相关的危险因素。从临床病历中收集了以下数据：年龄、性别、绝经状态（MP）、体重指数、吸烟习惯、疾病持续时间、每日剂量和累积糖皮质激素（GC）、器官受累类型、合并症和药物。收集了骨代谢、钙和维生素 D 补充剂以及双膦酸盐、特立帕肽或地舒单抗治疗的数据，以及骨密度（BMD）值（通过双能 X 射线吸收法（DXA）测量）和 FFx 病史（发生在 SLE 发病后且与创伤无关）。根据世界卫生组织（WHO）的定义，OP 和 BMD 降低被定义为。共纳入 186 例患者（女性 175 例，男性 11 例；平均年龄 46.4±13 岁，平均疾病持续时间 14.9±9 年）。在最后一次就诊时，97 例（52.2%）患者的 BMD 降低，52 例（27.9%）患者患有 OP。22 例（11.8%）、均为女性患者、至少发生过一次 FFx；6 例（27.3%）为绝经前。单因素分析显示，年龄、GC 累积剂量、MP、抗癫痫药物治疗和慢性肾功能衰竭（CRF）与 OP 相关（p<0.03）；年龄、总 GC 量、MP、CRF、抗凝剂（AC）和抗癫痫治疗与 FFx 相关（p<0.05）。多因素逻辑模型证实，OP 与年龄、MP 和抗癫痫治疗直接相关（p≤0.01），FFx 与年龄、慢性 AC 和抗癫痫治疗相关（p<0.03）。总之，SLE 患者常出现低 BMD，绝经前患者也会出现脆性骨折。除了传统的危险因素（年龄、MP 和 GC）外，CRF 和慢性使用 AC 或抗癫痫药物似乎与 OP 和 FFx 发生的风险增加有关。
