Systemic Autoimmune Diseases Research Unit, Hospital General Regional 36-CIBIOR, Instituto Mexicano del Seguro Social, Av. 10 Poniente 2721, Amor, 72090, Puebla, Puebla, Mexico.
Department of Immunology and Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico.
Calcif Tissue Int. 2017 Sep;101(3):291-299. doi: 10.1007/s00223-017-0286-z. Epub 2017 May 15.
The aim of this study was to evaluate possible associations between potential risk factors and the occurrence of established vertebral fractures (VF) in Mexican patients with systemic lupus erythematosus (SLE). Consecutive patients with SLE were enrolled in a prospective, observational study from 2006 to 2015. Information on potential risk factors, including demographics, clinical data, and bone mineral density (BMD) at the lumbar spine and hip on dual-energy X-ray absorptiometry was collected at baseline and follow-up. Semiquantitative analysis was used to determine incident VF on lateral thoracic and lumbar radiographs, defined as any vertebral body graded normal at baseline and at least mildly deformed (20-25% reduction or more in any vertebral height) during follow-up. Differences in baseline characteristics were assessed in patients with and without new radiographic VF. Of 110 SLE patients included, with a median follow-up of 8 (IQR 8-9) years, 22 (20%) had radiographic VF at baseline; 35 (32%) patients had a new VF. The annual incidence rate of new morphometric VF was 3.5 (95% CI 2.4-4.91) per 100 patient/years. Most fractures were mild or moderate and biconcave shaped. Incident VF were significantly associated with baseline BMD at the total hip and longer disease duration. Cumulative glucocorticoid dose, postmenopausal status, and previous prevalent VF were not associated with VF. In this SLE cohort in daily clinical practice, new VF were frequently present in SLE patients, especially those with longer disease duration and low-hip BMD.
本研究旨在评估潜在风险因素与已确立的椎体骨折（VF）在患有系统性红斑狼疮（SLE）的墨西哥患者中的发生之间的可能关联。2006 年至 2015 年期间，连续纳入了 SLE 患者进行前瞻性观察研究。基线和随访时收集了潜在风险因素的信息，包括人口统计学、临床数据和双能 X 射线吸收法测量的腰椎和髋部骨密度（BMD）。使用半定量分析来确定侧胸和腰椎 X 射线片上的新发 VF，定义为任何在基线时为正常且在随访期间至少轻度变形（任何椎体高度减少 20-25%或更多）的椎体。评估了基线特征在新发放射学 VF 患者和无新发放射学 VF 患者之间的差异。110 例 SLE 患者中，中位随访时间为 8（IQR 8-9）年，基线时有 22 例（20%）有放射学 VF；35 例（32%）患者有新发 VF。新发形态计量学 VF 的年发生率为 3.5（95%CI 2.4-4.91）/100 例患者/年。大多数骨折为轻度或中度，双凹形。新发 VF 与基线全髋骨密度和疾病持续时间较长显著相关。累积糖皮质激素剂量、绝经后状态和既往普遍存在的 VF 与 VF 无关。在本日常临床实践中的 SLE 队列中，新的 VF 在 SLE 患者中很常见，尤其是那些疾病持续时间较长和髋部 BMD 较低的患者。
