African Caribbean males have the highest BMD on a population level ever reported. Lean mass was the single most important correlate. Variability in BMD/BMAD was also explained by age, mixed African ancestry, anthropometric, lifestyle, and medical factors.

The epidemiologic information regarding international differences in bone mineral density (BMD) in women is currently insufficient. We compared BMD in older women across five racial/ethnic groups in four countries. The femoral neck, total hip, and lumbar spine BMD were measured in women (aged 65–74 years) from the Study of Osteoporotic Fractures (SOF) (5,035 Caucasian women and 256 African American women in the US), the Tobago Women’s Health Study (116 Afro-Caribbean women), the Ms Os Hong Kong Study (794 Hong Kong Chinese women) and the Namwon Study (1,377 South Korean women). BMD was corrected according to the cross-site calibration results for all scanners. When compared with US Caucasian women, the age adjusted mean BMD measurements at the hip sites were 21–31 % higher among Tobago Afro-Caribbean women and 13–23 % higher among African American women. The total hip and spine BMD values were 4–5 % lower among Hong Kong Chinese women and 4–7 % lower among South Korean women compared to US Caucasians. The femoral neck BMD was similar in Hong Kong Chinese women, but higher among South Korean women compared to US Caucasians. Current/past estrogen use was a significant contributing factor to the difference in BMD between US versus non-US women. Differences in body weight partially explained the difference in BMD between Asian versus non-Asian women. These findings show substantial racial/ethnic differences in BMD even within African or Asian origin individuals, and highlight the contributing role of body weight and estrogen use to the geographic and racial/ethnic variation in BMD.

The evidence from this literature review suggests that, while PML is a very rare disease in SLE patients, there does appear to be an increased risk of PML associated with SLE compared to the general population, potentially due to immunosuppression, other contributing factors in their underlying disease, treatments prescribed to manage disease, or some combination of these factors. Additional large observational studies, designed to assess exposure to drugs of interest and complicated treatment histories, are needed to provide further evidence about potential mechanisms contributing to the onset of PML in SLE patients.

In the UK, venlafaxine has been selectively prescribed to a patient population with a higher burden of suicide risk factors than patients prescribed fluoxetine and citalopram. Unless baseline population differences are accounted for, observational studies that compare the risk of suicide in patients receiving these agents may produce biased results.

Population dynamics predict a drastic growth in the number of older minority women, and resultant increases in the number of fractures. Low bone mineral density (BMD) is an important risk factor for fracture. Many studies have identified the lifestyle and health related factors that correlate with BMD in Whites. Few studies have focused on non-Whites. The objective of the current analyses is to examine the lifestyle, anthropometric and health related factors that are correlated with BMD in a population based cohort of Caribbean women of West African ancestry. We enrolled 340 postmenopausal women residing on the Caribbean Island of Tobago. Participants completed a questionnaire and had anthropometric measures taken. Hip BMD was measured by DXA. We estimated volumetric BMD by calculating bone mineral apparent density (BMAD). BMD was 10% and 20% higher across all age groups in Tobagonian women compared to US non-Hispanic Black and White women, respectively. In multiple linear regression models, 35-36% of the variability in femoral neck and total hip BMD respectively was predicted. Each 16 kilogram (one standard deviation (SD)) increase in weight was associated with 7% higher BMD; and weight explained over 10% of the variability of BMD. Each eight year (1 SD) increase in age was associated with 6% lower BMD. Current use of both thiazide diuretics and oral hypoglycemic medication were associated with 4-5% higher BMD. For femoral neck BMAD, 26% of the variability was explained by a multiple linear regression model. Current statin use was associated with 5% higher BMAD and a history of breast feeding or coronary heart disease were associated with 1-1.5% of higher BMAD. In conclusion, African Caribbean women have the highest BMD on a population level reported to date for women. This may reflect low European admixture. Correlates of BMD among Caribbean women of West African ancestry were similar to those reported for U.S. Black and White women.

ObjectiveTo assess the impact of mild-moderate systemic lupus erythematosus (SLE) disease activity during a 12-month period on the risk of death or subsequent organ system damage.Methods1168 patients with ≥24 months of follow-up from the Hopkins Lupus Cohort were included. Disease activity in a 12-month observation period was calculated using adjusted mean Safety of Estrogens in Lupus Erythematosus National Assessment (SELENA) version of the SLE Disease Activity Index (SLEDAI), defined as the area under the curve divided by the time interval. Damage accrual in the follow-up period was defined as change in Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) score ≥1 among patients without prior damage. Patients visited the clinic quarterly and had SELENA-SLEDAI and SDI assessed at every visit.ResultsDuring follow-up (median 7 years), 39% of patients accrued new damage in any organ system (7% cardiovascular and 3% renal) and 8% died. In adjusted models, an increased SELENA-SLEDAI score increased the risk of death (HR=1.22, 95% CI 1.13 to 1.32, p<0.001), renal damage (HR=1.24, 95% CI 1.08 to 1.42, p=0.003) and cardiovascular damage (HR=1.17, 95% CI 1.07 to 1.29, p<0.001). Hydroxychloroquine use reduced the risk of death (HR=0.46, 95% CI 0.29 to 0.72, p<0.05) and renal damage (HR=0.30, 95% CI 0.13 to 0.68, p<0.05). Non-steroidal anti-inflammatory drug use increased the risk of cardiovascular damage (HR=1.66, 95% CI 1.04 to 2.63, p<0.05). Without prior damage, an increased adjusted mean SELENA-SLEDAI score increased the risk of overall damage accrual (HR=1.09, 95% CI 1.04 to 1.15, p<0.001).ConclusionsEach one-unit increase in adjusted mean SELENA-SLEDAI during a 12-month observation period was associated with an increased risk of death and developing cardiovascular and renal damage.

Background SLE is an autoimmune disease typically affecting women of childbearing age that can be associated with significant maternal and fetal morbidity. Belimumab is a biologic approved as adjunctive therapy for SLE. Although pregnant women were excluded from belimumab clinical trials and treatment was discontinued if a pregnancy occurred, pregnancy outcomes were collected when a pregnancy was identified. Objectives To describe pregnancy outcomes of women who conceived while participating in belimumab phase 2-4 clinical trial studies. Methods Cumulative pregnancy outcome data with autoantibody status (when available) were collected from women who conceived while participating in belimumab SLE phase 2-4 clinical trials. Results As of 08 March 2013, 66 pregnancies with known outcomes in subjects who received belimumab and 6 who received placebo had been reported in the IV and SC SLE studies (Table). A lower frequency of fetal loss was noted in subjects treated with belimumab (27%; 18 of 66) compared to the placebo group (50%; 3 of 6). Live births were noted in 33 of 66 pregnancies (50%) in the belimumab group, 3 of which were associated with congenital anomalies (1 case of Dandy Walker syndrome, 1 case of bilateral enlarged kidneys in a pregnancy also exposed to a known teratogenic drug, and an unbalanced translocation involving chromosomes 11 and 13 that was linked to the mother). In the group receiving belimumab, anticardiolipin antibodies were present at baseline in 21% (7 of 33) of subjects who had live births and in 44% (8 of 18) of subjects with fetal loss. Conclusions Total fetal loss in belimumab-treated subjects was similar to background estimates in SLE patients (∼25%), although data remain limited. Valuable clinical information can be obtained through the Belimumab Pregnancy Registry (BPR), an international, prospective cohort study with voluntary participation. The BPR will add to current clinical experience with belimumab and assist clinicians and patients regarding potential risks and benefits of treating SLE patients who are contemplating pregnancy or are pregnant. GSK1550188; eTrack Study #201182 References Andrade R, Sanchez ML, Alarcon GS, et al. Adverse pregnancy outcomes in women with systemic lupus erythematosus from a multiethnic US cohort: LUMINA (LU1). Clin Exp Rheumatol. 2008;26:268-74. Clowse ME, Magder LS, Witter F et al. The impact of increased lupus activity on obstetric outcomes. Arthritis Rheum. 2005;52:514-21. Rahman P, Gladman DD, Urowitz MB. Clinical predictors of fetal outcome in systemic lupus erythematosus. J Rheumatol. 1998; 25.8:1526-30. Disclosure of Interest M. Powell Shareholder of: GlaxoSmithKline, Employee of: GlaxoSmithKline, D. Hill Shareholder of: GlaxoSmithKline, Employee of: GlaxoSmithKline, A. Eudy Employee of: GlaxoSmithKline, H. Landy Consultant for: GlaxoSmithKline, M. Petri Consultant for: GlaxoSmithKline DOI 10.1136/annrheumdis-2014-eular.4484

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