Increased risk of osteoporosis and fracture in women with systemic sclerosis: A comparative study with rheumatoid arthritis

Abstract

Objective. To investigate whether women with systemic sclerosis (SSc) have an increased risk of osteoporosis (OP) and related fractures compared to a high-risk population with rheumatoid arthritis (RA) and also healthy controls, and to determine putative specific OP and fracture risk factors. Methods. We performed a cross-sectional study with successive inclusion of age-matched healthy women and women with SSc and RA. Risk factors for OP and fracture were collected for all patients. Bone mineral density (BMD) was systematically measured at the lumbar spine and total hip region with dual x-ray absorptiometry.

Increased risk of osteoporotic fractures in patients with systemic sclerosis: a nationwide population-based study

“…However, we believe that these results were limited by the small sample size because the rates of osteoporosis and BMD in the SSc cohort were similar to those of rheumatoid arthritis. A case–control study by Weiss et al indicated an increased risk of hip fracture in SSc patients compared with healthy controls11; this was further supported by the cross-sectional study of Avouac et al , which reported a significantly higher prevalence of OF in 71 SSc patients compared with 227 healthy controls 13. Several results of the present study are consistent with these results.…”

“…Up to 23–58% of the SSc patients in various studies had been exposed to glucocorticoids 13 17 19 24. We determined that a 4.75-fold fracture risk occurred in SSc patients when the daily dose was >7.5 mg of prednisolone equivalents.…”

Rheumatoid arthritis patients with hip fracture: a nationwide study

“…Lee et al reported that below-normal bone mineral density (BMD) was significantly more prevalent among patients with RA patients than among those without RA (7.8 vs. 1.0 %, respectively) [16]. Similar findings have been reported in patients with other rheumatologic disorders such as systemic scleroderma [5]. Glucocorticoid administration may play a pivotal role in RA-related bone loss via several different mechanisms [25].…”

“…In particular, vitamin D deficiency is common in patients with RA, even those who regularly take supplements [21]. A low 25(OH) D level has been identified as an independent risk factor for fractures in RA [5]. However, information about individuals' use of vitamin D and calcium supplements was not available in this database.…”

“…The mechanism of bone loss in RA patients is still unclear, but it is believed to be related to an imbalance in the ratio of receptor activator of NF-kB ligand and osteoprotegerin [4]. Osteoporosis, a major risk factor for fracture, represents an important co-morbidity for RA patients and other rheumatologic diseases, such as systemic sclerosis [5]. The World Health Organization's fracture assessment tool has also pinpointed RA as a risk for fracture [6].…”