Monash University, Clayton, Victoria, Australia.
Department of Rheumatology, Monash Health, Clayton, Victoria, Australia.
Int J Rheum Dis. 2022 Feb;25(2):175-181. doi: 10.1111/1756-185X.14254. Epub 2021 Dec 2.
Despite reports of decreased bone mineral density in patients with systemic sclerosis (SSc) in international cohorts, the prevalence of osteoporosis in Australian SSc patients remains unknown. We report rates of dual-energy X-ray absorptiometry (DXA) scanning in an SSc cohort at a tertiary hospital specialized outpatient clinic and the prevalence and associations of osteoporosis in screened patients.
We performed retrospective chart review to determine if patients underwent DXA scanning between 2007 and 2018 and extracted lumbar spine and femoral neck T-scores, fracture history, and osteoporosis therapy.
Of 244 patients, 104 (42.6%) underwent DXA scanning and among patients in whom T-scores were available (n = 91), 30 (33.0%) had osteoporosis and 48 (52.7%) had osteopenia. Screened patients were more likely to have longer disease duration (19.9 vs 15.2 years, P = 0.002), calcinosis (50.5% vs 36.4%, P = 0.028), myositis (12.6% vs 0.7%, P < 0.001), synovitis (42.7% vs 28.6%, P = 0.022), ever used prednisolone (76.7% vs 47.1%, P < 0.001) or fractures (23.0% vs 0.0%, P < 0.001). Patients with osteoporosis more commonly had a history of nasogastric feeding, percutaneous endoscopic gastrostomy feeding or intravenous total parenteral nutrition (6.9% vs 0.0%, P = 0.038) and, unexpectedly, less commonly ever used prednisolone (58.6% vs 85.2%, P = 0.005) compared with patients with osteopenia or normal bone density.
We identified high rates of osteoporosis among screened Australian SSc patients. Further assessment in larger, prospective studies is needed to establish guidelines for formal osteoporosis screening in SSc patients.
尽管国际队列研究报告系统性硬皮病（SSc）患者的骨密度降低，但澳大利亚 SSc 患者骨质疏松症的患病率仍不清楚。我们报告了一家三级医院专门的门诊诊所 SSc 队列中双能 X 射线吸收法（DXA）扫描的发生率以及筛查患者中骨质疏松症的患病率和相关性。
我们进行了回顾性图表审查，以确定 2007 年至 2018 年期间患者是否进行了 DXA 扫描，并提取了腰椎和股骨颈 T 评分、骨折史和骨质疏松症治疗情况。
在 244 名患者中，有 104 名（42.6%）进行了 DXA 扫描，在可获得 T 评分的患者中（n = 91），有 30 名（33.0%）患有骨质疏松症，48 名（52.7%）患有骨质减少症。筛查患者更有可能患有更长的疾病病程（19.9 年 vs 15.2 年，P = 0.002）、钙质沉着症（50.5% vs 36.4%，P = 0.028）、肌炎（12.6% vs 0.7%，P < 0.001）、滑膜炎（42.7% vs 28.6%，P = 0.022）、曾使用泼尼松龙（76.7% vs 47.1%，P < 0.001）或骨折（23.0% vs 0.0%，P < 0.001）。骨质疏松症患者更常见有鼻胃管喂养、经皮内镜胃造口术喂养或静脉全胃肠外营养的病史（6.9% vs 0.0%，P = 0.038），出人意料的是，与骨质减少症或正常骨密度患者相比，他们使用泼尼松龙的频率更低（58.6% vs 85.2%，P = 0.005）。
我们发现筛查出的澳大利亚 SSc 患者中骨质疏松症的发生率很高。需要更大规模的前瞻性研究进一步评估，以确定 SSc 患者正式骨质疏松症筛查的指南。
