Predictors of fracture risk in patients with systemic lupus erythematosus

Abstract

Objectives Bone loss in systemic lupus erythematosus is multifactorial. Recent studies demonstrate corticosteroids, previous fractures and increasing age decrease bone mineral density. The effect of body mass index and fat mass are less well characterized. We sought to determine fracture risk factors in patients undergoing dual-energy X-ray absorptiometry scanning at a district hospital in 2004-2015. Methods Standard dual-energy X-ray absorptiometry parameters were recorded, plus rheumatoid arthritis diagnosis, smoking status, alcohol consumption, family history of fractures, history of secondary operation and corticosteroid use. Data were analyzed using Fisher's exact test for categorical data and logistic regression for continuous data. Results One hundred and fifty patients (141 women, nine men) with SLE were included; 52 (34.6%) had sustained at least one fracture. Fracture risk increased with increased age, body mass index, fat mass and average tissue thickness, and decreased lean mass (adjusted for steroid use), as well as with smoking and rheumatoid arthritis. Increased femoral and vertebral bone mineral density conversely decreased fracture risk. Conclusion Our study suggests increased age, body mass index, fat mass, smoking and/or rheumatoid arthritis increase fracture risk in SLE patients. To our knowledge, this is the first demonstration of a correlation between increased fat mass, adjusted for steroid use and fracture risk, in adults, potentially indicating a differential effect of fat on bone metabolism and lessening of lean body mass.

Smoking, alcohol consumption and disease-specific outcomes in rheumatic and musculoskeletal diseases (RMDs): systematic reviews informing the 2021 EULAR recommendations for lifestyle improvements in people with RMDs

“…In one study, past or current smoking (vs never) was significantly associated with increased risk of organ damage (HR 1.7, 95% CI 1.1 to 2.6). 58 In other studies, smoking was associated with increased: risk of lung cancer 59 ; odds of thrombotic events 60 61 ; frequency, odds and risk of CV and cerebrovascular events 62–64 ; odds of fracture 65 ; odds of cutaneous damage and odds of early myocardial infarction. 66 Three studies did not find any association between smoking and the risk of myocardial infarction and/or stroke, 67 depression 68 and cutaneous features of active lupus, 69 respectively.…”

Sarcopenia e excesso de peso em mulheres portadoras de lúpus eritematoso sistêmico

“…In view of the compromised quality of life resulting from SLE, patients who manifest musculoskeletal and body composition changes are dependent on the performance of routine activities and greater physical inactivity, greater perception of pain in muscles and joints, greater neurocognitive impairment, increased risk of fracture, increased risk of cardiovascular complications, metabolic syndrome and ovarian failure, further compromising quality of life [9][10][11][12][13][14][15].…”

Fatty Acid Composition of Proximal Femur Bone Marrow Adipose Tissue in Subjects With Systemic Lupus Erythematous Using 3 T Magnetic Resonance Spectroscopy

“…[6][7][8] Women with lupus may be nearly five times more likely to experience a fracture from poor bone quality, and fractures frequently occur in the femur, resulting in decreased quality of life and a mortality rate as high as nearly 25% in the first year after femur fracture. [9][10][11][12][13] The standard-of-care test used to assess bone quality is dual-energy x-ray absorptiometry (DXA) assessment of BMD; however, as a 2D planar technique, DXA does not assess all the changes in bone tissue that can occur in SLE and does not entirely capture fracture risk. Bone marrow is an important component of bone tissue, and biopsies have shown that bone marrow is one of the organ targets affected by immune mechanisms in active SLE.…”

“…Recent studies have shown that SLE patients have higher fracture rates, even when controlling for BMD and other variables suggesting disease‐specific risk, which is independent of BMD 6–8 . Women with lupus may be nearly five times more likely to experience a fracture from poor bone quality, and fractures frequently occur in the femur, resulting in decreased quality of life and a mortality rate as high as nearly 25% in the first year after femur fracture 9–13 . The standard‐of‐care test used to assess bone quality is dual‐energy x‐ray absorptiometry (DXA) assessment of BMD; however, as a 2D planar technique, DXA does not assess all the changes in bone tissue that can occur in SLE and does not entirely capture fracture risk.…”