Le B, Waller J L, Radhakrishnan R, Oh S J, Kheda M F, Nahman N S, Carbone L
1 Department of Internal Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA.
2 Charlie Norwood VA Medical Center, Augusta, Georgia, USA.
Lupus. 2018 Jan;27(1):17-24. doi: 10.1177/0961203317709953. Epub 2017 May 22.
Background The incidence of end stage renal disease (ESRD) in patients with systemic lupus erythematosus (SLE) is rising. However, the relationship between osteoporotic fractures and SLE in the setting of ESRD remains uninvestigated. The purpose of this study was to compare the frequency of incident osteoporotic fractures in patients with ESRD with and without SLE, to identify risk factors for fractures in patients with SLE and ESRD, and to examine the contribution of these fractures to mortality. Methods Retrospective cohort study of patients with SLE ( n = 716) and a 5% random sample of controls without SLE ( n = 4176) in the United States Renal Data System (USRDS) from years 2006-2008 enrolled in Medicare Part D. Results Fractures occurred in 10.6% ( n = 76) of patients with SLE and ESRD and 12.1% ( n = 507) of patients with ESRD without SLE ( p = 0.24). Older age (adjusted relative risk 1.02, 95% confidence interval 1.01-1.04) was associated with an increased risk for fracture in patients with SLE and ESRD. In multivariable analyses, vertebral and hip fractures more than doubled the risk for mortality. Conclusions The frequency of osteoporotic fractures in patients with SLE and ESRD is similar to the general population of patients with ESRD. Vertebral and hip fractures are significant contributors to mortality in patients with SLE and ESRD. Fracture prevention, in particular, for elderly patients with SLE and ESRD, should be considered. Summary SLE is not an independent risk factor for fractures in patients with ESRD. However, among patients with SLE and ESRD, vertebral and hip fractures are significant contributors to mortality.
背景 系统性红斑狼疮（SLE）患者终末期肾病（ESRD）的发病率正在上升。然而，在ESRD背景下骨质疏松性骨折与SLE之间的关系仍未得到研究。本研究的目的是比较有和没有SLE的ESRD患者中骨质疏松性骨折的发生频率，确定SLE和ESRD患者骨折的危险因素，并研究这些骨折对死亡率的影响。方法 对2006 - 2008年美国肾脏数据系统（USRDS）中参加医疗保险D部分的SLE患者（n = 716）和5%无SLE的对照随机样本（n = 4176）进行回顾性队列研究。结果 SLE和ESRD患者中有10.6%（n = 76）发生骨折，无SLE的ESRD患者中有12.1%（n = 507）发生骨折（p = 0.24）。年龄较大（调整后相对风险1.02，95%置信区间1.01 - 1.04）与SLE和ESRD患者骨折风险增加相关。在多变量分析中，椎体和髋部骨折使死亡风险增加一倍以上。结论 SLE和ESRD患者中骨质疏松性骨折的频率与ESRD患者总体人群相似。椎体和髋部骨折是SLE和ESRD患者死亡的重要因素。应考虑预防骨折，特别是对于老年SLE和ESRD患者。总结 SLE不是ESRD患者骨折的独立危险因素。然而，在SLE和ESRD患者中，椎体和髋部骨折是死亡的重要因素。
