Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Dermatology, Data Science Institute, Vanderbilt University Medical Center, Nashville, TN, USA.
Lupus. 2021 Mar;30(3):403-411. doi: 10.1177/0961203320979735. Epub 2020 Dec 13.
SummaryPatients with systemic lupus erythematosus (SLE) have an increased risk of developing osteoporosis and fractures due to systemic inflammation and glucocorticoids (GCs). Professional organizations recommend bone mineral density (BMD) testing in SLE patients on GCs, especially within 6 months of initiation. Using a validated algorithm, we identified SLE patients in an electronic health record cohort with long-term GC exposure (≥90 days). Our primary outcome was ever BMD testing. We assessed the impact of patient and provider factors on testing. We identified 693 SLE cases with long-term GC exposure, 41% of whom had BMD testing performed. Only 18% of patients had BMD testing within 6 months of GC initiation. In a logistic regression model for BMD testing, male sex (OR = 0.49, 95% CI 0.27 - 0.87, p = 0.01) was associated with being less likely to have BMD testing after adjusting for race and ethnicity. In contrast, older age (OR = 1.04, p < 0.001) and nephritis (OR = 1.83, p = 0.003) were associated with being more likely to have BMD testing after adjusting for race and ethnicity. Bone health in SLE patients remains an area in need of improvement with attention to patients who are younger and male.
系统性红斑狼疮（SLE）患者由于全身炎症和糖皮质激素（GCs）的存在，发生骨质疏松症和骨折的风险增加。专业组织建议对接受 GCs 治疗的 SLE 患者进行骨密度（BMD）检测，尤其是在开始治疗后的 6 个月内。我们使用经过验证的算法，在电子病历队列中确定了有长期 GC 暴露（≥90 天）的 SLE 患者。我们的主要结局是是否进行过 BMD 检测。我们评估了患者和提供者因素对检测的影响。我们确定了 693 例有长期 GC 暴露的 SLE 病例，其中 41%的患者进行了 BMD 检测。只有 18%的患者在 GC 开始后 6 个月内进行了 BMD 检测。在 BMD 检测的逻辑回归模型中，男性（OR=0.49，95%CI 0.27-0.87，p=0.01）在调整种族和民族后，不太可能进行 BMD 检测。相比之下，年龄较大（OR=1.04，p<0.001）和肾炎（OR=1.83，p=0.003）在调整种族和民族后，更有可能进行 BMD 检测。SLE 患者的骨骼健康仍然需要改善，需要关注年龄较小和男性患者。
