Risk factors for osteoporosis and fragility fractures in patients with systemic lupus erythematosus

Abstract

Osteoporosis (OP) and fragility fractures (FFx) are a known comorbidity in patients with systemic lupus erythematosus (SLE). This work aimed at evaluating (1) the prevalence of OP and FFx in a cohort of SLE and (2) the risk factors associated with both OP and FFx. The following data were collected from clinical charts: age, sex, menopausal status (MP), body mass index, smoking habits, disease duration, daily dose and cumulative glucocorticoids (GCs), type of organ involvement, comorbidities and medications. Data on bone metabolism, calcium and vitamin D supplementation and treatment with bisphosphonates, teriparatide or denosumab were collected, together with bone mineral density (BMD) values (measured by dual-energy X-ray absorptiometry (DXA)) and history of FFx (occurred after the onset of SLE and unrelated to trauma). OP and reduced BMD were defined according to the WHO. 186 patients were included (women 175, men 11; mean age 46.4±13 years, mean disease duration 14.9±9 years). At their last visit, 97 patients (52.2%) had a reduced BMD and 52 (27.9%) had OP. 22 patients (11.8%), all women, had at least one FFx; six patients (27.3%) were pre-menopausal. On univariate analysis, age, cumulative dose of GC, MP, therapy with antiepileptics and chronic renal failure (CRF) were correlated with OP (p<0.03); age, total amount of GC, MP, CRF, anticoagulants (AC) and antiepileptic therapy were correlated with FFx (p<0.05). The multivariate logistic model confirmed a direct association of OP and age, MP and antiepileptic therapy (p≤0.01) and of FFx and age, chronic therapy with AC and antiepileptics (p<0.03). In conclusion, low BMD is frequently observed in SLE, and FFx are observed also in premenopausal patients. Together with traditional risk factors (age, MP and GC), CRF and chronic treatments with AC or antiepileptics seem to be associated with a higher risk profile for OP and FFx occurrence.

Prevalence and incidence of osteoporotic fractures in patients on long-term glucocorticoid treatment for rheumatic diseases: the Glucocorticoid Induced OsTeoporosis TOol (GIOTTO) study

“…In our study the prevalence of osteoporosis in patients with CTDs (mainly SLE) was of 28% at the spine and 18% at the hip. Recently, Carli et al observed that more than 50% of SLE patients chronically treated with GCs had a reduced BMD and 28% had osteoporosis (33). In previous studies the prevalence of osteoporosis in GC treated patients with SLE ranged from 1.4 to 68% (34,35).…”

Seizures as a clinical manifestation in somatic autoimmune disorders

“…It is however reasonable to carefully consider these comorbidities when choosing an anti-epileptic drug (AED). For example, people with systemic autoimmune diseases are at risk for osteoporosis due to glucocorticoid use [119,120] which can be further increased by certain AEDs particularly enzyme inducing AEDs [121]. In people with MS, small-sized studies indicated that use of AEDs, especially carbamazepine, are associated with increased risk of vertigo, fatigue, cognitive slowing, and even relapse-like side-effects [122,123].…”

Why targeted therapies are necessary for systemic lupus erythematosus

“…Osteoporosis, by densiometry, and fragility fractures have been associated with SLE(12) and in particular with prednisone therapy(13) . This is the most commonly reported item on the American College of Rheumatology/ Systemic Lupus International Collaborating Clinics damage index (ACR/SLICC SDI)(14).…”

“…This is the most commonly reported item on the American College of Rheumatology/ Systemic Lupus International Collaborating Clinics damage index (ACR/SLICC SDI)(14). Patients with SLE also have a significantly higher risk of vertebral fractures than controls, and the majority of these fractures occur in pre-menopausal women(13, 15, 16). Zonana-Nacach et al (17) found that cumulative corticosteroid dose was most strongly associated with osteoporotic fractures, with a 2.5-fold increased risk for each decade of prednisone at 10 mg/day or more (which persisted with adjustment for age, gender, ethnicity, and exposure to high-dose and pulse therapy).…”