Sampaio-Barros Marília M, Bortoluzzo Adriana B, da Silva Henrique Carriço, Luppino-Assad Ana Paula, Pereira Rosa Maria R, Sampaio-Barros Percival D
Disciplina de Reumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil.
Insper-Instituto de Educação e Pesquisa, Sao Paulo, Brazil.
J Scleroderma Relat Disord. 2023 Feb;8(1):79-84. doi: 10.1177/23971983221141271. Epub 2022 Dec 8.
This case-control study analyzed risk factors for symptomatic fractures in a group of 52 patients with systemic sclerosis compared with a group of 104 patients without fractures, matched for sex and age, who were attended at a single systemic sclerosis outpatient clinic from 2010 to 2020. Fractures affected predominantly vertebral (65.4%), rib (13.5%), and hip (7.7%) joints, while the mean age of fracture was 55.3 ± 9.5 years. Age at disease onset, age at diagnosis, disease duration, age at menarche, and age at menopause were similar in both groups, and 58.9% of the patients were menopausal at the time of the fracture. The presence of fractures had a significant association with densitometric osteoporosis (p < 0.001), lower weight (p = 0.032), and bone mineral index (p = 0.044), anti-RNA polymerase III (p = 0.040), use of corticosteroids (p = 0.019), and bisphosphonates (p < 0.001), as well as with densitometric T-scores of lumbar spine (p < 0.001), femoral neck (p = 0.025), and total hip (p = 0.013). Multivariate analysis showed that the variables significantly associated with fractures were high doses of corticosteroids (odds ratio = 4.10; 95% confidence interval = 1.290-13.090; p = 0.017), bisphosphonates (odds ratio = 3.91; 95% confidence interval = 1.699-8.984; p = 0.001), negative anti-Scl70 (OR = 0.34; 95% confidence interval = 0.124-0.943; p = 0.038), and lumbar T-score (odds ratio = 0.39; 95% confidence interval = 0.034-0.460; p = 0.010). In conclusion, symptomatic fractures were associated predominantly with lower bone mineral density of lumbar spine and use of high doses of corticosteroids and bisphosphonates in this cohort.
本病例对照研究分析了52例系统性硬化症患者发生症状性骨折的危险因素，并与104例未发生骨折的患者进行比较，后者与前者性别和年龄相匹配，均于2010年至2020年在一家系统性硬化症门诊就诊。骨折主要累及椎体（65.4%）、肋骨（13.5%）和髋关节（7.7%），骨折的平均年龄为55.3±9.5岁。两组患者的发病年龄、诊断年龄、病程、初潮年龄和绝经年龄相似，58.9%的患者在骨折时已绝经。骨折的发生与骨密度测定的骨质疏松症（p<0.001）、体重较低（p=0.032）、骨矿物质指数（p=0.044）、抗RNA聚合酶III（p=0.040）、使用皮质类固醇（p=0.019）和双膦酸盐（p<0.001）以及腰椎（p<0.001）、股骨颈（p=0.025）和全髋关节（p=0.013）的骨密度T值显著相关。多变量分析显示，与骨折显著相关的变量为高剂量皮质类固醇（比值比=4.10；95%置信区间=1.290-13.090；p=0.017）、双膦酸盐（比值比=3.91；95%置信区间=1.699-8.984；p=0.001）、抗Scl70阴性（OR=0.34；95%置信区间=0.124-0.943；p=0.038）和腰椎T值（比值比=0.39；95%置信区间=0.034-0.460；p=0.010）。总之，在该队列中，症状性骨折主要与腰椎骨密度较低以及高剂量皮质类固醇和双膦酸盐的使用有关。
