Rheumatology Department, Sheba Medical Center, Ramat Gan, Israel.
Internal Medicine Department, Pedro Hispano Hospital, Porto, Portugal.
Rheumatology (Oxford). 2021 Jun 18;60(6):2765-2772. doi: 10.1093/rheumatology/keaa705.
Chronic glucocorticoid use is complicated by osteoporosis and increases the risk of fragility fractures. EULAR guidelines on SLE management recommend reducing chronic glucocorticoid dosage to ≤7.5 mg/day to minimize this risk. We examined the relationship of glucocorticoid dose to fragility fracture risk in a cohort of SLE patients.
Retrospective analysis of SLE patients attending University College Hospital over 28 years was undertaken. Collected data included consecutive steroid dose, dual-energy X-ray absorptiometry scans and fragility fractures.
We collected data on 250 patients with a median of 17 years' follow-up. Fragility fractures were diagnosed in 28 (11.2%) patients and the mean ± s.d. age of first fracture was 51 ± 16 years. A total of 94% received glucocorticoids, the average dose being 6.20 mg/day. Patients with fragility fractures had a lower average daily dose (5.36 vs 6.23 mg/day) but a higher median cumulative dose (25.19 vs 20.96 g). These differences were not significant (P = 0.127 and 0.229, respectively). Some 93% of patients received vitamin D, and 85% received calcium. Cox regression analysis showed older age at SLE diagnosis, osteoporosis and secondary hyperparathyroidism were associated with fragility fractures. Glucocorticoid dose was not significantly associated with the occurrence of fragility fractures. Twenty-two patients with fractures were treated with bisphosphonates, two with denosumab and two with teriparatide.
We found no significant association between glucocorticoid treatment and fragility fractures in our group of patients; however, a prospective study including more patients not treated with CS would be necessary to confirm these results.
长期使用糖皮质激素会导致骨质疏松症，并增加脆性骨折的风险。EULAR 狼疮管理指南建议将慢性糖皮质激素剂量减少至≤7.5mg/天，以最大限度地降低这种风险。我们在一组狼疮患者中检查了糖皮质激素剂量与脆性骨折风险的关系。
对 28 年来在大学医院就诊的狼疮患者进行回顾性分析。收集的数据包括连续的类固醇剂量、双能 X 射线吸收法扫描和脆性骨折。
我们收集了 250 名患者的数据，中位随访时间为 17 年。28 名（11.2%）患者诊断为脆性骨折，首次骨折的平均年龄为 51±16 岁。94%的患者接受了糖皮质激素治疗，平均剂量为 6.20mg/天。脆性骨折患者的平均日剂量较低（5.36 与 6.23mg/天），但中位数累积剂量较高（25.19 与 20.96g）。这些差异无统计学意义（P=0.127 和 0.229）。约 93%的患者接受了维生素 D 治疗，85%的患者接受了钙治疗。Cox 回归分析显示，狼疮诊断时年龄较大、骨质疏松症和继发性甲状旁腺功能亢进与脆性骨折有关。糖皮质激素剂量与脆性骨折的发生无显著相关性。22 名骨折患者接受了双膦酸盐治疗，2 名接受了地舒单抗治疗，2 名接受了特立帕肽治疗。
我们没有发现我们组患者中糖皮质激素治疗与脆性骨折之间存在显著关联；然而，需要进行一项包括更多未接受 CS 治疗患者的前瞻性研究来证实这些结果。
