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Ji W, Pan B, Chen X, Lao Z, Yang W, Qian Y. Mendelian randomization studies of risk and protective factors for osteoporosis: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2025; 15:1486188. [PMID: 39886030 PMCID: PMC11779621 DOI: 10.3389/fendo.2024.1486188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2024] [Accepted: 12/20/2024] [Indexed: 02/01/2025] Open
Abstract
Background Mendelian randomization is believed to attenuate the biases inherent in observational studies, yet a meta-analysis of Mendelian randomization studies in osteoporosis has not been conducted thus far. This study aims to evaluate the connection between potential causal factors and the risk of osteoporosis by synthesizing evidence from Mendelian randomization studies. Methods The databases PubMed, Web of Science, and Embase were systematically searched for Mendelian randomization studies investigating factors influencing osteoporosis up to May 2024. Meta-analyses were conducted to assess the associations between various potential pathogenic factors and osteoporosis using Mendelian Randomization studies. The quality of the study was evaluated according to the Strengthening the Reporting of Observational Studies in Epidemiology via Mendelian Randomization (STROBE-MR) guidelines. Results A total of 706 potentially relevant articles were screened, resulting in the inclusion of 53 studies in the systematic review, of which 30 were eligible for the meta-analysis. The combined findings from these 30 studies revealed that rheumatoid arthritis, inflammatory bowel disease, sex hormone binding globulin, depression, non-alcoholic fatty liver disease, primary biliary cholangitis and asthma are associated with increased risk of osteoporosis, while basal metabolic rate and gut microbiota (NB1n) serves as a protective factor. However, the association between obesity, type 2 diabetes mellitus, metformin, ulcerative colitis, leisure sedentary behaviors, systemic lupus erythematosus, serum iron and osteoporosis was found to be nonsignificant. Conclusion In summary, our meta-analysis indicates that significant causal relationships with osteoporosis's onset and progression have been established for rheumatoid arthritis, inflammatory bowel disease, primary biliary cholangitis, non-alcoholic fatty liver disease, depression, sex hormone binding globulin, basal metabolic rate, gut microbiota (NB1n), and asthma. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier PROSPERO CRD42024540504.
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Affiliation(s)
- Wenhao Ji
- Department of Orthopedics Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Bin Pan
- Department of Orthopedics Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Xin Chen
- Department of Orthopedics Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Zhaobai Lao
- Department of Orthopedics Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Wanlei Yang
- Department of Orthopedics Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yu Qian
- Department of Orthopedics Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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2
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Chen Z, Dai Y, Gao F, Liu J, He J, Zhang L, Wu Y. Integrative analysis of crosstalk genes and diagnostic biomarkers in lupus-associated osteoporosis. Int J Immunopathol Pharmacol 2025; 39:3946320251331842. [PMID: 40298129 PMCID: PMC12041714 DOI: 10.1177/03946320251331842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2024] [Accepted: 03/16/2025] [Indexed: 04/30/2025] Open
Abstract
Systemic lupus erythematosus (SLE) patients are at greater risk of developing osteoporosis (OP) than the general population. This study aimed to identify crosstalk genes between SLE and OP and to validate their diagnostic accuracy as biomarkers. Data analysis based on Gene Expression Omnibus (GEO) datasets was conducted. We utilized Weighted Gene Co-Expression Network Analysis (WGCNA) and differential expression analysis to identify crosstalk genes (CGs). Machine learning algorithms and consensus clustering were applied to screen shared diagnostic biomarkers and construct two predictive models featuring key genes. We also investigated potential subgroups, immune infiltration across different subtypes, and validated hub mRNAs using quantitative real-time PCR (qPCR). Molecular docking was performed to simulate the interaction of a small molecule compound with its target. We identified 19 CGs and developed two predictive models: the IL1R2-GADD45B and CHI3L1-IL1R2-SPTLC2 diagnostic score thresholds. The CHI3L1-IL1R2-SPTLC2 model showed improved predictive accuracy for lupus-associated osteoporosis. The C2 subtype was found to potentially regulate bone metabolism in SLE patients. Immune infiltration analysis indicated a strong association between CGs and multiple immunocytes, with IL1R2 being a common element in both models. Molecular docking suggests that Anakinra's therapeutic effect may involve IL1R2. Our study introduces novel diagnostic biomarkers and predictive models for lupus-associated osteoporosis, with a particular focus on IL1R2 as an innovative biomarker and therapeutic target. These are anticipated to aid early screening and risk assessment in SLE patients, pending large-scale clinical validation.
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Affiliation(s)
- Zhihan Chen
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Rheumatology, Fujian Provincial Hospital, Fuzhou, China
| | - Yunfeng Dai
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Rheumatology, Fujian Provincial Hospital, Fuzhou, China
| | - Fei Gao
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Rheumatology, Fujian Provincial Hospital, Fuzhou, China
| | - Jianwen Liu
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Rheumatology, Fujian Provincial Hospital, Fuzhou, China
| | - Juanjuan He
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Rheumatology, Fujian Provincial Hospital, Fuzhou, China
| | - Li Zhang
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Nephrology, Fujian Provincial Hospital, Fuzhou, China
| | - Yanfang Wu
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Rheumatology, Fujian Provincial Hospital, Fuzhou, China
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3
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Charatcharoenwitthaya K, Suntrapiwat K, Wongtrakul W. The Association Between Tuberculosis and Osteoporosis: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e76397. [PMID: 39867096 PMCID: PMC11762585 DOI: 10.7759/cureus.76397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2024] [Indexed: 01/28/2025] Open
Abstract
Recent research suggests that tuberculosis (TB) may pose a potential risk factor for osteoporosis, although the available evidence remains limited. This study aimed to comprehensively assess osteoporosis risk in TB patients through systematic review and meta-analysis methodology. Two investigators independently conducted a literature search using the Medical Literature Analysis and Retrieval System Online (MEDLINE) and Excerpta Medica Database (EMBASE) databases up to April 2024. Eligible longitudinal cohort studies had to evaluate the impact of active or a history of TB on the risk of osteoporosis and/or osteoporotic fractures. Point estimates and standard errors from each eligible study were pooled using DerSimonian and Laird's generic inverse variance method. Of 2,062 articles (1,765 from EMBASE and 297 from MEDLINE) reviewed, three retrospective cohort studies, comprising a total of 531,624 participants (174,726 patients with TB and 356,898 participants without TB), met the eligibility criteria and were included in the meta-analysis. The pooled analysis of three studies revealed an increased risk of osteoporosis among TB patients, with a pooled hazard ratio of 1.40 (95% CI, 1.26 - 1.57; I2 = 54%). The pooled analysis indicated that populations with TB also had a higher risk of osteoporotic fractures than populations without TB, with a pooled hazard ratio of 1.65 (95% CI, 1.26 - 2.15; I2 = 71%). Our systematic review and meta-analysis demonstrated a significantly increased risk of osteoporosis and osteoporotic fractures in patients with TB.
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Affiliation(s)
| | - Kajorn Suntrapiwat
- Pulmonary Diseases and Critical Care Medicine, Buddhachinaraj Hospital, Phitsanulok, THA
| | - Wasit Wongtrakul
- Internal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, THA
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4
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Hong Y, Yang Y, Yao Y. Prevalence and risk factors of osteoporosis in lupus nephritis patients in China: a cross-sectional study. BMC Nephrol 2024; 25:428. [PMID: 39604881 PMCID: PMC11604019 DOI: 10.1186/s12882-024-03882-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 11/22/2024] [Indexed: 11/29/2024] Open
Abstract
BACKGROUND Osteoporosis is a significant concern among individuals with lupus nephritis (LN), with reported prevalence rates exhibiting considerable variation. This study investigates the prevalence and identifies risk factors contributing to osteoporosis in premenopausal and postmenopausal LN patients, addressing the paucity of data specific to the Chinese population. METHODS This cross-sectional study enrolled patients with renal biopsy-proven LN, who underwent bone mineral density (BMD) measurements using dual X-ray absorptiometry at the lumbar spine, total hip, and femoral neck. The study was conducted at Tongji hospital from May 2011 to June 2018. RESULTS A total of 130 patients were evaluated, with a mean age of 46.2 ± 12.9 years, including 2 males and 128 females. A significant majority, 52.3% (n = 67) of the female patients, were identified as postmenopausal. BMD measurements revealed that 40.0% of patients had osteoporosis in at least one site. The spearman rank correlation of BMD with clinical characteristics indicated that age at menopause, weight, height, and body mass index were positively correlated with BMD, while age, age at diagnosis of LN, and menopause duration were negatively correlated with BMD in lumbar spine, total hip, and/or femoral neck. Multivariable linear regression analysis demonstrated that body mass index was positively associated with BMD, whereas disease duration and menopause duration were negatively associated with BMD in all and postmenopausal patients. Postmenopausal patients consistently had a higher prevalence of osteoporosis across all measured sites. Factors such as older age, lower weight, and the absence of bisphosphonates therapy were independently associated with an increased risk of osteoporosis in LN patients. CONCLUSION Our findings underscore a substantial prevalence of osteoporosis in LN patients, especially among postmenopausal individuals. The study identifies older age, lower weight, and absence of bisphosphonates treatment as risk factors for osteoporosis in this patient population.
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Affiliation(s)
- Yu Hong
- Department of Nephrology, Tongji hospital affiliated to Tongji medical college, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yi Yang
- Department of Nephrology, Tongji hospital affiliated to Tongji medical college, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Ying Yao
- Department of Nephrology, Tongji hospital affiliated to Tongji medical college, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Department of Nutrition, Tongji hospital affiliated to Tongji medical college, Huazhong University of Science and Technology, Wuhan, Hubei, China
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5
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Zhang G, Li B, Xia Y. Identifying Key Genes and Their Associated Molecular Pathways in Lupus Nephritis-Osteoporosis: An In-Silico Analysis. J Clin Densitom 2024; 27:101524. [PMID: 39213724 DOI: 10.1016/j.jocd.2024.101524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/20/2024] [Accepted: 08/09/2024] [Indexed: 09/04/2024]
Abstract
Nephritis and osteoporosis are debilitating medical conditions that significantly impact human health and reduce quality of life. To develop potential therapeutic strategies for these disorders necessitates understanding the genetic and molecular mechanisms. Here, we employed bioinformatics techniques purposed to find key genes and associated pathways responsible for nephritis-osteoporosis comorbidity. Six microarray datasets of systemic lupus erythematosus (SLE) and osteoporosis were retrieved from the Gene Expression Omnibus (GEO) database. Post normalization of data sets LIMMA package was utilized for differential expression analysis, among the datasets 44 differentially expressed genes (DEGs) were identified. The identified 44 genes were further analyzed for gene ontology (GO) where it was found that these genes are involved in defense response, organism interactions, and response to external stimuli. In predicting the molecular function, they were involved in several biological processes including binding to lipopolysaccharides and having peptidase and hydrolase activities. Firstly, the identified genes were primarily associated with certain granules such as specific granules and secretory granules in the aspect of cellular components. Enrichment analysis pointed out the potential pathways linked to the immune system, neutrophil degranulation, innate immunity, and immune response to tuberculosis. To examine interactions among DEGs, a complex protein-protein interaction (PPI) network was built, resulting in the identification of seven hub genes, CXCL8, ELANE, LCN2, MMP8, IFIT1, MX1, and ISG15. The study suggests that these elucidated hub genes might have high potential to be exploited as promising biomarkers and therapeutic targets in nephritis-osteoporosis. Taken together, this study provided deeper insights into the genetic and molecular basis for the comorbidity of nephritis and osteoporosis.
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Affiliation(s)
- Guangdi Zhang
- Department of Nephrology, Affiliated Hospital of Nantong University, No.20, Xisi Road, Nantong, Jiangsu 226001, PR China
| | - Bo Li
- Department of Nephrology, Affiliated Hospital of Nantong University, No.20, Xisi Road, Nantong, Jiangsu 226001, PR China
| | - Yun Xia
- Department of Geriatrics, First People's Hospital of Nantong, No.666, Shengli Road, Nantong, Jiangsu 226001, PR China.
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6
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Palmowski A, Schmajuk G, Yazdany J, Katz P, Li J, Stovall R, Kersey E, Nielsen SM, Christensen R, Bliddal H, Boyadzhieva Z, Schneider U, Alexander T, Muche B, Hermann S, Wiebe E, Buttgereit F. Proton Pump Inhibitor Use and Bone Health in Patients With Rheumatic Diseases: A Cross-Sectional Study. Mayo Clin Proc 2024; 99:1046-1057. [PMID: 38752948 DOI: 10.1016/j.mayocp.2023.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 10/27/2023] [Accepted: 12/12/2023] [Indexed: 07/05/2024]
Abstract
OBJECTIVE To assess the effect of proton pump inhibitor (PPI) use on bone mineral density (BMD) and bone microarchitecture as measured by the trabecular bone score (TBS) in patients with inflammatory rheumatic and musculoskeletal diseases (iRMDs). METHODS Cross-sectional data from a prospective single-center cohort (2015 to 2022) of patients with iRMDs were used to evaluate 3 co-primary outcomes: BMD of the left femoral neck and the lumbar spine (as T-scores) and the TBS. Inverse probability weighting adjusted for numerous confounders including age, sex, body mass index, current and cumulative glucocorticoid (GC) dose, C-reactive protein levels, disability, and others. Analyses were based on general linear models, following a prespecified statistical analysis plan. RESULTS The study included 1495 patients (75% women; mean age, 62.6±13.1 years; 49% and 63% with regular PPI and GC use, respectively). The PPI users had lower BMD at both spine (adjusted contrast -0.25; 95% CI, -0.47 to -0.04; P=.02) and femoral neck (-0.17 [-0.35 to 0.01]; P=.07). Differences between PPI users and nonusers were statistically significant only in patients concurrently using GCs at more than 7.5 mg/d prednisone equivalent. The TBS was similar in PPI users and nonusers (adjusted contrast, 0.00 [-0.04 to 0.04]; P=.97). CONCLUSION Our results suggest that PPIs lead to a loss of BMD rather than an impairment of bone microarchitecture in patients with iRMDs. The negative association between PPI use and BMD appears to be dependent on concurrent GC use. Clinicians should carefully review the indication for PPI use in patients with iRMDs, especially in those receiving higher dose GCs.
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Affiliation(s)
- Andriko Palmowski
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark; Division of Rheumatology, University of California San Francisco, San Francisco, CA
| | - Gabriela Schmajuk
- Division of Rheumatology, University of California San Francisco, San Francisco, CA
| | - Jinoos Yazdany
- Division of Rheumatology, University of California San Francisco, San Francisco, CA
| | - Patricia Katz
- Division of Rheumatology, University of California San Francisco, San Francisco, CA
| | - Jing Li
- Division of Rheumatology, University of California San Francisco, San Francisco, CA
| | - Rachael Stovall
- Division of Rheumatology, University of California San Francisco, San Francisco, CA
| | - Emma Kersey
- Division of Rheumatology, University of California San Francisco, San Francisco, CA
| | - Sabrina M Nielsen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Henning Bliddal
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Zhivana Boyadzhieva
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Udo Schneider
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Alexander
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Burkhard Muche
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sandra Hermann
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Edgar Wiebe
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Abstract
Importance Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by inflammation and immune-mediated injury to multiple organ systems, including the mucocutaneous, musculoskeletal, hematologic, and kidney systems. Approximately 3.4 million people worldwide have received a diagnosis of SLE. Observations Approximately 90% of people with SLE are female. Although there are no uniformly accepted diagnostic criteria for SLE, the 2019 European Alliance of Associations for Rheumatology (formerly the European League Against Rheumatism)/American College of Rheumatology classification criteria developed for scientific study are an estimated 96.1% sensitive and 93.4% specific for SLE. These classification criteria include both clinical factors, such as fever, cytopenia, rash, arthritis, and proteinuria, which may be indicative of lupus nephritis; and immunologic measures, such as SLE-specific autoantibodies and low complement levels. Approximately 40% of people with SLE develop lupus nephritis, and an estimated 10% of people with lupus nephritis develop end-stage kidney disease after 10 years. The primary goal of treatment is to achieve disease remission or quiescence, defined by minimal symptoms, low levels of autoimmune inflammatory markers, and minimal systemic glucocorticoid requirement while the patient is treated with maintenance doses of immunomodulatory or immunosuppressive medications. Treatment goals include reducing disease exacerbations, hospitalizations, and organ damage due to the disease or treatment toxicity. Hydroxychloroquine is standard of care for SLE and has been associated with a significant reduction in mortality. Treatments in addition to hydroxychloroquine are individualized, with immunosuppressive agents, such as azathioprine, mycophenolate mofetil, and cyclophosphamide, typically used for treating moderate to severe disease. Three SLE medications were recently approved by the Food and Drug Administration: belimumab (for active SLE in 2011 and for lupus nephritis in 2020), voclosporin (for lupus nephritis), and anifrolumab (for active SLE). Conclusions and Relevance Systemic lupus erythematosus is associated with immune-mediated damage to multiple organs and increased mortality. Hydroxychloroquine is first-line therapy and reduces disease activity, morbidity, and mortality. When needed, additional immunosuppressive and biologic therapies include azathioprine, mycophenolate mofetil, cyclophosphamide, belimumab, voclosporin, and anifrolumab.
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Affiliation(s)
- Caroline H Siegel
- Division of Rheumatology, Hospital for Special Surgery, New York, New York
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Lisa R Sammaritano
- Division of Rheumatology, Hospital for Special Surgery, New York, New York
- Department of Medicine, Weill Cornell Medicine, New York, New York
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8
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Nakajima T, Doi H, Watanabe R, Murata K, Takase Y, Inaba R, Itaya T, Iwasaki T, Shirakashi M, Tsuji H, Kitagori K, Akizuki S, Nakashima R, Onishi A, Yoshifuji H, Tanaka M, Ito H, Hashimoto M, Ohmura K, Morinobu A. Factors associated with osteoporosis and fractures in patients with systemic lupus erythematosus: Kyoto Lupus Cohort. Mod Rheumatol 2023; 34:113-121. [PMID: 36680424 DOI: 10.1093/mr/road014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/06/2023] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Osteoporosis and compression fractures of the lumbar spine are some of the major adverse effects of glucocorticoid therapy in patients with systemic lupus erythematosus (SLE). This study examined the association between bone mineral density, bone turnover markers, presence of vertebral fractures, and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index in SLE patients. METHODS This was a cross-sectional study of 246 outpatients with SLE at the Kyoto University Hospital. Lumbar and femoral bone mineral density was measured with dual-energy X-ray absorptiometry, and the presence of vertebral fractures was determined using X-ray, computed tomography, or magnetic resonance imaging. RESULTS On multiple regression analysis, both high lumbar and femoral T-scores were associated with the concomitant use of hydroxychloroquine (P = .018 and P = .037, respectively), no use of bisphosphonate or denosumab (P = .004 and P = .038, respectively), high body mass index (P < .001), and low bone-specific alkaline phosphatase level (P = .014 and P = .002, respectively). Vertebral fractures showed a significant association with Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index score (P < .001) and femoral T-score (P < .001). CONCLUSION Vertebral fracture was associated with SLE-associated organ damage, and serum bone-specific alkaline phosphatase level is a potentially useful marker for osteoporosis monitoring in SLE patients.
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Affiliation(s)
- Tomoya Nakajima
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Doi
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryu Watanabe
- Department of Clinical Immunology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koichi Murata
- Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yudai Takase
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryuta Inaba
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takahiro Itaya
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Takeshi Iwasaki
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mirei Shirakashi
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hideaki Tsuji
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koji Kitagori
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuji Akizuki
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ran Nakashima
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akira Onishi
- Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hajime Yoshifuji
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masao Tanaka
- Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiromu Ito
- Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Motomu Hashimoto
- Department of Clinical Immunology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Koichiro Ohmura
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akio Morinobu
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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9
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Boyadzhieva Z, Palmowski A, Buttgereit F, Hoff P. [Trabecular bone score in rheumatology : Are there benefits in comparison to bone densitometry alone?]. Z Rheumatol 2023; 82:672-677. [PMID: 37646845 DOI: 10.1007/s00393-023-01407-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 09/01/2023]
Abstract
Patients with inflammatory rheumatic diseases have an increased risk of fractures due to the inflammatory potential of the disease and also because of the treatment with glucocorticoids that is often necessary. According to the current guidelines of the Governing Body on Osteology (DVO), the fracture risk can be assessed using dual energy X‑ray absorptiometry and can also be supplemented by measuring the trabecular bone score (TBS). The assessment of the TBS offers additional advantages, for example in glucocorticoid-induced osteoporosis and in patients with osteoproliferative changes of the spine (spondylarthritis) and thus optimizes the fracture risk assessment in the rheumatological patient population.
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Affiliation(s)
- Zhivana Boyadzhieva
- Med. Klinik mit Schwerpunkt Rheumatologie und klinische Immunologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - Andriko Palmowski
- Med. Klinik mit Schwerpunkt Rheumatologie und klinische Immunologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, University of Copenhagen, Kopenhagen, Dänemark
| | - Frank Buttgereit
- Med. Klinik mit Schwerpunkt Rheumatologie und klinische Immunologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Paula Hoff
- Med. Klinik mit Schwerpunkt Rheumatologie und klinische Immunologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
- MVZ Endokrinologikum Berlin am Gendarmenmarkt, Berlin, Deutschland
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10
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Ceccarelli F, Olivieri G, Orefice V, Picciariello L, Natalucci F, Conti F. Fragility fractures in lupus patients: Associated factors and comparison of four fracture risk assessment tools. Lupus 2023; 32:1320-1327. [PMID: 37698854 DOI: 10.1177/09612033231202701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
OBJECTIVE Osteoporosis (OP) and fragility fractures (FF) are common comorbidities in patients with systemic lupus erythematosus (SLE). This study aimed to (1) assess the prevalence of these conditions in a cohort of SLE patients (2) evaluate the risk factors associated with FF, and (3) compare the accuracy of four different FF risk assessment algorithms to determine which performs better in this specific rheumatologic population. MATERIALS AND METHODS We conducted a cross-sectional study with SLE women who underwent bone mineral density assessment by dual-energy X-ray absorptiometry (DEXA) within 3 months of their last visit. Conventional radiology methods were used to evaluate the presence of FF. The 10-year risk of osteoporotic fractures was estimated using four tools: DeFRA, FRAX (adjusted for GC dosage), GARVAN, and QFracture. The comparison of these computational tools was analyzed by the area under the receiver operating characteristic (ROC) curves. RESULTS We analyzed 86 SLE patients with a median age of 56 years (IQR 12.1) and a median age at diagnosis of 34 years (IQR 17.2). The median T-score values at the femoral neck and lumbar spine were -1.6 (IQR 0.9) and -1.7 (IQR 1.1), respectively. Of the patients, 33 (38.4%) had OP, with 13 patients (15.1%) experiencing FF. Univariate analysis showed that the presence of FF was associated with thrombocytopenia (p = .01), hemolytic anemia (p = .0001), and the intake of cyclosporine A (p = .002), cyclophosphamide (p = .006), and rituximab (p = .001). The median 10-year risk of major FF for the four calculation tools were as follows: DeFRA 9.85 (IQR 8.6); FRAX GC 8.8 (IQR11.7); GARVAN 12 (IQR 8.2); QFracture 4.1 (IQR 5.8). We observed a significant correlation among all instruments evaluated (p < .0001); in particular, the best correlation was recorded between the FRAX GC and the DeFRA (r = 0.85). DeFRA was the best tool for this population with an AUC of 0.94 (p < .0001, CI 0.88-1). CONCLUSIONS OP is a common comorbidity in SLE patients, even in younger patients. FF appears to be more frequent in patients with hematologic involvement. The comparison of the four algorithms shows that DeFRA is the most accurate tool and should be applied to SLE patients.
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Affiliation(s)
- Fulvia Ceccarelli
- Department of Clinical Internal, Anesthesiologic and Cardiovascular, Sciences, Sapienza University of Rome, Rome, Italy
| | - Giulio Olivieri
- Department of Clinical Internal, Anesthesiologic and Cardiovascular, Sciences, Sapienza University of Rome, Rome, Italy
- Molecular Medicine and Applied Biotechnology, University of Rome Tor Vergata, Rome, Italy
| | - Valeria Orefice
- Department of Clinical Internal, Anesthesiologic and Cardiovascular, Sciences, Sapienza University of Rome, Rome, Italy
| | - Licia Picciariello
- Department of Clinical Internal, Anesthesiologic and Cardiovascular, Sciences, Sapienza University of Rome, Rome, Italy
| | - Francesco Natalucci
- Department of Clinical Internal, Anesthesiologic and Cardiovascular, Sciences, Sapienza University of Rome, Rome, Italy
| | - Fabrizio Conti
- Department of Clinical Internal, Anesthesiologic and Cardiovascular, Sciences, Sapienza University of Rome, Rome, Italy
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11
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Rios C, Maldonado G, Vargas S, González J, Vera C, Zuñiga A, Martínez J, Castillo M, Jervis R, Ventura R, Guevara S, Torres G, Uguña F, Messina OD, Neyro JL, Fernández D, Guerrero R, Moreno M. First Ecuadorian statement consensus for the evaluation and treatment of osteoporosis. Arch Osteoporos 2023; 18:81. [PMID: 37316765 DOI: 10.1007/s11657-023-01263-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/09/2023] [Indexed: 06/16/2023]
Abstract
Osteoporosis management has become more relevant as the life expectancy increases. In Ecuador, approximately 19% of adults over 65 years of age have been diagnosed with osteoporosis. There is no national consensus for the management and prevention of the disease being this proposal the first Ecuadorian consensus. INTRODUCTION In Ecuador, it is estimated that around 19% of adults over 65 years of age have osteoporosis. Due to the increase in life expectancy in the world population, the evaluation and management of osteoporosis has become more relevant. Currently, there is no national consensus for the management and prevention of the disease. The Ecuadorian Society of Rheumatology presented the project for the elaboration of the first Ecuadorian consensus for the management and prevention of osteoporosis. METHODS A panel of experts in multiple areas and extensive experience was invited to participate. The consensus was carried out using the Delphi method. Six working dimensions were created: definition and epidemiology of osteoporosis, fracture risk prediction tools, non-pharmacological treatment, pharmacological treatment, calcium and vitamin D, and glucocorticoid-induced osteoporosis. RESULTS The first round was held in December 2021, followed by the second round in February 2022 and the third round in March 2022. The data was shared with the specialists at the end of each round. After three rounds of work, a consensus was reached for the management and prevention of osteoporosis. CONCLUSION This is the first Ecuadorian consensus for the management and treatment of postmenopausal osteoporosis.
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Affiliation(s)
- Carlos Rios
- Ecuadorian Society of Rheumatology, Guayaquil, Ecuador
| | | | - Sara Vargas
- Ecuadorian Society of Rheumatology, Guayaquil, Ecuador
| | - José González
- Ecuadorian Society of Rheumatology, Guayaquil, Ecuador
| | - Claudia Vera
- Ecuadorian Society of Rheumatology, Guayaquil, Ecuador
| | - Andrés Zuñiga
- Ecuadorian Society of Rheumatology, Guayaquil, Ecuador
| | - José Martínez
- Ecuadorian Society of Rheumatology, Guayaquil, Ecuador
| | | | - Raúl Jervis
- Ecuadorian Society of Rheumatology, Guayaquil, Ecuador
| | - Rosa Ventura
- Ecuadorian Society of Rheumatology, Guayaquil, Ecuador
| | | | | | | | | | - José Luis Neyro
- Obstetrics and Gynecology Department, Cruces University Hospital, Vasco Country University EHU-UPV, Baracaldo Bizkaia, Spain
| | - Daniel Fernández
- Rheumatology Department, San Ignacio University Hospital, Bogota, Colombia
| | | | - Mario Moreno
- Ecuadorian Society of Rheumatology, Guayaquil, Ecuador
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12
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Cabling MG, Sandhu VK, Downey CD, Torralba KD. Cardiovascular disease and bone health in aging female rheumatic disease populations: A review. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231155286. [PMID: 36825447 PMCID: PMC9969471 DOI: 10.1177/17455057231155286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Rheumatic diseases cover a wide spectrum of conditions, including primary and secondary degenerative joint diseases and autoimmune inflammatory rheumatic diseases. The risks of cardiovascular disease and osteoporosis and resultant fractures in aging female rheumatic disease populations, especially those with autoimmune rheumatic diseases, are increased. Changes in the immune system in aging populations need to be considered especially among patients with autoimmune rheumatic diseases. Immunosenescence is closely aligned to reduced adaptive immunity and increased non-specific innate immunity leading to chronic inflammation of inflammaging. The effective use of disease-modifying antirheumatic drugs to control autoimmune rheumatic diseases may also mitigate factors leading to cardiovascular disease and osteoporosis. Rheumatic diseases, which largely manifest as arthritis, predispose patients to premature joint degeneration and poor bone health and therefore have a higher risk of developing end-stage arthritis requiring joint arthroplasties sooner or more often than other patients without rheumatic disease.
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Affiliation(s)
- Marven G Cabling
- Division of Rheumatology, Department of Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Vaneet K Sandhu
- Division of Rheumatology, Department of Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Christina D Downey
- Division of Rheumatology, Department of Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Karina D Torralba
- Division of Rheumatology, Department of Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA
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13
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Kozyreva MV, Nikitinskaya OA, Toroptsova NV. Trabecular bone score in rheumatic disease. RHEUMATOLOGY SCIENCE AND PRACTICE 2022. [DOI: 10.47360/1995-4484-2022-587-59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Patients with rheumatic diseases (RD) are at high risk of osteoporosis (OP) and osteoporotic fractures. The Trabecular bone score (TBS) is a relatively novel method of assessing bone quality, which independently predicts fracture risk regardless of bone mineral density (BMD). A lower TBS in patients with RD compared to controls is shown in most studies concerning TBS and RD. The data obtained indicate that TBS predicts fractures better in RD, especially in patients receiving glucocorticoids, than BMD or the FRAX algorithm. TBS degradation has been associated with disease activity in ankylosing spondylitis, systemic sclerosis, and rheumatoid arthritis in a few studies. However, there is little data in the literature on the effect of rheumatic disease therapy and OP treatment in patients with RD on predictive ability of TBS for incident fracture.
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14
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Goodwin Davies AJ, Xiao R, Razzaghi H, Bailey LC, Utidjian L, Gluck C, Eckrich D, Dixon BP, Deakyne Davies SJ, Flynn JT, Ranade D, Smoyer WE, Kitzmiller M, Dharnidharka VR, Magnusen B, Mitsnefes M, Somers M, Claes DJ, Burrows EK, Luna IY, Furth SL, Forrest CB, Denburg MR. Skeletal Outcomes in Children and Young Adults with Glomerular Disease. J Am Soc Nephrol 2022; 33:2233-2246. [PMID: 36171052 PMCID: PMC9731624 DOI: 10.1681/asn.2021101372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 08/10/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Children with glomerular disease have unique risk factors for compromised bone health. Studies addressing skeletal complications in this population are lacking. METHODS This retrospective cohort study utilized data from PEDSnet, a national network of pediatric health systems with standardized electronic health record data for more than 6.5 million patients from 2009 to 2021. Incidence rates (per 10,000 person-years) of fracture, slipped capital femoral epiphysis (SCFE), and avascular necrosis/osteonecrosis (AVN) in 4598 children and young adults with glomerular disease were compared with those among 553,624 general pediatric patients using Poisson regression analysis. The glomerular disease cohort was identified using a published computable phenotype. Inclusion criteria for the general pediatric cohort were two or more primary care visits 1 year or more apart between 1 and 21 years of age, one visit or more every 18 months if followed >3 years, and no chronic progressive conditions defined by the Pediatric Medical Complexity Algorithm. Fracture, SCFE, and AVN were identified using SNOMED-CT diagnosis codes; fracture required an associated x-ray or splinting/casting procedure within 48 hours. RESULTS We found a higher risk of fracture for the glomerular disease cohort compared with the general pediatric cohort in girls only (incidence rate ratio [IRR], 1.6; 95% CI, 1.3 to 1.9). Hip/femur and vertebral fracture risk were increased in the glomerular disease cohort: adjusted IRR was 2.2 (95% CI, 1.3 to 3.7) and 5 (95% CI, 3.2 to 7.6), respectively. For SCFE, the adjusted IRR was 3.4 (95% CI, 1.9 to 5.9). For AVN, the adjusted IRR was 56.2 (95% CI, 40.7 to 77.5). CONCLUSIONS Children and young adults with glomerular disease have significantly higher burden of skeletal complications than the general pediatric population.
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Affiliation(s)
- Amy J Goodwin Davies
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rui Xiao
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hanieh Razzaghi
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - L Charles Bailey
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Levon Utidjian
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Caroline Gluck
- Division of Nephrology, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, Delaware
| | - Daniel Eckrich
- Division of Nephrology, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, Delaware
| | - Bradley P Dixon
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
- Children's Hospital Colorado, Aurora, Colorado
| | | | - Joseph T Flynn
- Department of Pediatrics, University of Washington, Seattle, Washington
- Seattle Children's Hospital, Seattle, Washington
| | | | - William E Smoyer
- Department of Pediatrics, The Ohio State University, Columbus, Ohio
- Nationwide Children's Hospital, Columbus, Ohio
| | | | - Vikas R Dharnidharka
- Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri
- St. Louis Children's Hospital, St. Louis, Missouri
| | | | - Mark Mitsnefes
- Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Michael Somers
- Boston Children's Hospital, Harvard University, Boston, Massachusetts
| | - Donna J Claes
- Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Evanette K Burrows
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ingrid Y Luna
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Susan L Furth
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christopher B Forrest
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michelle R Denburg
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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15
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Martel D, Saxena A, Belmont HM, Honig S, Chang G. Fatty Acid Composition of Proximal Femur Bone Marrow Adipose Tissue in Subjects With Systemic Lupus Erythematous Using 3 T Magnetic Resonance Spectroscopy. J Magn Reson Imaging 2022; 56:618-624. [PMID: 34964533 PMCID: PMC10023192 DOI: 10.1002/jmri.28038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a chronic, inflammatory disease with common musculoskeletal manifestations, notably reductions in bone quality. Bone marrow adipose tissue composition and quantity has been previously linked to bone quality and may play a role in SLE pathophysiology but has not been thoroughly studied. PURPOSE To use magnetic resonance spectroscopy (MRS) to investigate bone marrow adipose tissue quantity and composition in proximal femur subregions of untreated SLE patients compared to controls and treated patients. STUDY TYPE Prospective. SUBJECTS A total of 64 female subjects: 28 SLE, 15 glucocorticoid (GC)-treated SLE and 21 matched controls. FIELD STRENGTH/SEQUENCE Stimulated echo acquisition mode (STEAM) sequence at 3 T. ASSESSMENT MRS was performed at multiple echo times in the femoral neck and trochanter regions and fatty acids (FA) composition was computed. STATISTICAL TESTS Intergroup comparisons were carried out using ANOVA. A P value < 0.05 was considered statistically significant. RESULTS SLE patients had significantly higher saturated FA compared to controls in both the femoral neck (+0.12) and trochanter (+0.11), significantly lower monounsaturated FA in the trochanter compared to controls (-0.05), and significantly lower polyunsaturated FA in the femoral neck compared to both controls (-0.07) and SLE patients on GC therapy (-0.05). DATA CONCLUSION SLE patients have altered proximal femur marrow fat metabolism, which may reflect a manifestation of, or play a role in, the altered inflammatory response of these patients. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Dimitri Martel
- New York Langone Health, Department of Radiology, New York, New York, USA
| | - Amit Saxena
- New York Langone Health, Division of Rheumatology, Hospital for Joint Diseases, New York, New York, USA
| | - Howard Michael Belmont
- New York Langone Health, Division of Rheumatology, Hospital for Joint Diseases, New York, New York, USA
| | - Stephen Honig
- New York Langone Health, Osteoporosis Center, Hospital for Joint Diseases, New York, New York, USA
| | - Gregory Chang
- New York Langone Health, Department of Radiology, New York, New York, USA
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16
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Mok CC. Osteoporosis in Rheumatic Diseases. JOURNAL OF CLINICAL RHEUMATOLOGY AND IMMUNOLOGY 2022. [DOI: 10.1142/s2661341722300026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The risk of osteoporosis and fragility fracture is increased in patients with autoimmune rheumatic diseases. Although the use of glucocorticoids is the major contributing factor, inflammation mediated by cytokines and growth factors and other medications, including the biologic and targeted disease-modifying antirheumatic drugs, also play important roles in bone remodeling. Pro-inflammatory cytokines such as IL-1, IL-6, IL-17, and TNF[Formula: see text] increase RANK expression and promote osteoclast activity while inhibiting osteoblast-mediated bone formation through the Dickkopf-1 pathway. Certain autoantibodies stimulate differentiation of the osteoclasts, resulting in localized bone resorption. This article covers the prevalence and risk factors for osteoporosis in patients with common rheumatic diseases and the role of inflammatory cytokines and other clinical factors. Controlling disease-related inflammation and optimizing the diagnostic and therapeutic instrumentation is needed to reduce fragility fractures in patients with rheumatic diseases.
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Affiliation(s)
- Chi Chiu Mok
- Department of Medicine, Tuen Mun Hospital, Hong Kong SAR, China
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17
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Ishida T, Yuri H, Nakamura E, Isoda K, Wada Y, Kotani T, Takeuchi T. Low pre-pregnant body mass index is a risk factor for the decrease of postpartum bone mineral density in systemic lupus erythematosus patients received glucocorticoid therapy. Lupus 2022; 31:848-854. [PMID: 35440212 DOI: 10.1177/09612033221094710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study investigated postpartum bone mineral density (BMD) in patients with systemic lupus erythematosus (SLE) receiving long-term glucocorticoid (GC) therapy, assessed risk factors for decreased postpartum BMD, and evaluated change of BMD after postpartum initiation or restarting of osteoporosis drugs. METHODS We retrospectively examined 30 SLE patients who gave birth and 31 non-pregnant SLE patients. In the postpartum SLE patients, BMD was measured after delivery and 1 year later. Multivariate analyses were performed to assess risk factors for decreased BMD in postpartum SLE patients. RESULTS Patient age at pregnancy was 34.5 ± 4.5 years, and SLE duration was 9.7 ± 6.0 years. The mean prednisolone dose was 9.7 ± 3.2 mg/day. Body mass index (BMI) was 21.6 ± 2.2 kg/m2, with 13 women (43%) experiencing their first delivery. Postpartum BMD was 1.080 ± 0.120 g/cm2 in the lumbar spine and 0.834 ± 0.109 g/cm2 in the total hip. Bone loss occurred in six patients (21%) in the lumbar spine and 11 patients (37%) in the total hip. Postpartum lumbar spine BMD was significantly reduced compared to that in the non-pregnant group (1.143 ± 0.120 g/cm2, p = 0.048). Multivariate analysis identified gestational age and low BMI before pregnancy as risk factors for hip bone loss. CONCLUSION Postpartum BMD significantly decrease in SLE patients receiving long-term GC, and low BMI before pregnancy was a risk factor for the decrease. Preconception care to prevent osteoporosis and that regularly monitors BMD after delivery are needed.
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Affiliation(s)
- Takaaki Ishida
- Division of Rheumatology, Department of Internal Medicine (IV), 13010Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan.,Department of Internal Medicine, Santamaria Hospital, Osaka, Japan
| | - Hiramatsu Yuri
- Division of Rheumatology, Department of Internal Medicine (IV), 13010Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Eri Nakamura
- Division of Rheumatology, Department of Internal Medicine (IV), 13010Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Kentaro Isoda
- Division of Rheumatology, Department of Internal Medicine (IV), 13010Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan.,Department of Rheumatology and Allergology, National Hospital Organization Osaka Minami Medical Center, Osaka, Japan
| | - Yumiko Wada
- Division of Rheumatology, Department of Internal Medicine (IV), 13010Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Takuya Kotani
- Division of Rheumatology, Department of Internal Medicine (IV), 13010Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Tohru Takeuchi
- Division of Rheumatology, Department of Internal Medicine (IV), 13010Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
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Abstract
Inflammation is among the major determinants of bone loss in chronic disease and aging. Bone metabolism is radically affected by inflammation with consequent bone loss and increased fracture risk. Various cytokines and mediators are involved in the pathogenesis of bone loss in inflammatory conditions. The present review has the aim of discussing the main pathways involved in the pathogenesis of bone loss in inflammatory diseases, focusing in particular on the Wnt system and its regulators. Literature review of studies published between inception to 2021 on osteoporosis and inflammation was conducted. I will discuss the epidemiology of osteoporosis and fractures in common inflammatory diseases. The molecular basis of bone loss related to inflammation will be discussed as well. Finally, the effects of various anti-inflammatory medications on bone metabolism will be reviewed.
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Affiliation(s)
- Giovanni Adami
- Rheumatology Unit, University of Verona, Pz Scuro 10, Verona, Italy.
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19
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Mok CC, Tse SM, Chan KL, Ho LY. Estimation of fracture risk by the FRAX tool in patients with systemic lupus erythematosus: a 10-year longitudinal validation study. Ther Adv Musculoskelet Dis 2022; 14:1759720X221074451. [PMID: 35154418 PMCID: PMC8832570 DOI: 10.1177/1759720x221074451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/01/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The fracture risk assessment tool has been widely used to stratify the 10-year fracture risk to guide therapy. Using the actual fracture data of a 10-year longitudinal cohort of older patients with systemic lupus erythematosus, we reported an underestimation of the tool in predicting major symptomatic osteoporotic fractures. Treatment of osteoporosis in systemic lupus erythematosus should not be based on fracture risk estimation alone. Relevant time-dependent risk factors should be taken into account for an individualized decision. OBJECTIVE To compare the observed fracture incidence in a 10-year longitudinal cohort of patients with systemic lupus erythematosus (SLE) with the fracture risk prediction from the fracture risk assessment (FRAX) tool. METHODS Adult patients (⩾40 years) with SLE who had a first DEXA scan performed in 2005-2009 were studied. The 10-year rates of major osteoporotic and hip fractures were estimated by FRAX using clinical data at DEXA with adjustment for prednisolone dosage. The actual incidence of clinical fractures at 10 years was compared with the estimated rates. Factors associated with new fractures were studied by logistic regression. RESULTS A total of 229 SLE patients were studied (age: 50.2 ± 6.6 years, 93% women). Glucocorticoid was used in 148 (65%) patients at baseline (mean dose: 7.3 ± 6.9 mg/day; 34% ⩾ 7.5 mg/day). Osteoporosis (bone mineral density T score ⩽ -2.5) at the hip, femoral neck, or spine was present in 61 (27%) patients. The estimated 10-year risk of major osteoporotic and hip fractures by FRAX was 3.4 ± 4.5% and 0.95 ± 2.3%, respectively. After 10 years, three patients developed hip fracture, 6 patients had limb fractures and 20 patients had symptomatic vertebral fractures (major osteoporotic fracture 12.7%, hip fracture 1.3%). The actual major osteoporotic fracture rate was significantly higher than the FRAX estimation (12.7% vs 3.4%; p < 0.001). Logistic regression revealed that osteoporosis (odds ratio (OR): 4.07 [1.51-10.9]), previous fragility fracture (OR: 3.18 [1.02-9.90]), and a parental history of fracture (OR: 4.44 [1.16-17.0]) were independently associated with new clinical fractures at 10 years. CONCLUSION The FRAX tool underestimates the major clinical fracture risk at 10 years in patients with SLE.
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Affiliation(s)
- Chi Chiu Mok
- Department of Medicine, Tuen Mun Hospital, Tsing Chung Koon Road, New Territories, Tuen Mun, Hong Kong SAR, China
| | - Sau Mei Tse
- Department of Medicine, Tuen Mun Hospital, Hong Kong SAR, China
| | - Kar Li Chan
- Department of Medicine, Tuen Mun Hospital, Hong Kong SAR, China
| | - Ling Yin Ho
- Department of Medicine, Tuen Mun Hospital, Hong Kong SAR, China
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20
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Nordqvist J, Engdahl C, Scheffler JM, Gupta P, Gustafsson KL, Lagerquist MK, Carlsten H, Islander U. A tissue-selective estrogen complex as treatment of osteoporosis in experimental lupus. Lupus 2022; 31:143-154. [PMID: 35062848 PMCID: PMC8832562 DOI: 10.1177/09612033211067984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Osteoporosis is a common secondary complication in patients with systemic lupus erythematosus (SLE). Current osteoporosis treatment with bisphosphonates has some negative side effects and there is a lack of data regarding newer treatments options for SLE associated osteoporosis. The tissue-selective estrogen complex (TSEC) containing conjugated estrogens and the selective estrogen receptor modulator bazedoxifene (Bza) is approved for treatment of postmenopausal vasomotor symptoms and prevention of osteoporosis. However, it has not been evaluated for treatment of osteoporosis in postmenopausal SLE patients. Ovariectomized MRL/lpr mice constitute a model for postmenopausal lupus that can be used for osteoporosis studies. We used this model in a set of experiments where the mice were treated with different doses of 17β-estradiol-3-benzoate (E2), Bza, or TSEC (E2 plus Bza), administered in the early or late phases of disease development. The skeleton was analyzed by dual-energy X-ray absorptiometry, peripheral quantitative computed tomography, and high-resolution microcomputed tomography. The lupus disease was assessed by determination of proteinuria, hematuria, and lupus disease markers in serum. Treatment with medium dose TSEC administered in early disease protected ovariectomized MRL/lpr mice from trabecular bone loss, while there were no differences in lupus disease parameters between treatments. This is the first experimental study to investigate TSEC as a potential new therapy for osteoporosis in postmenopausal SLE.
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Affiliation(s)
- Jauquline Nordqvist
- Department of Rheumatology and Inflammation Research, 70712University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Cecilia Engdahl
- Department of Rheumatology and Inflammation Research, 70712University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden.,Department of Internal Medicine and Clinical Nutrition, 70712University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Julia M Scheffler
- Department of Rheumatology and Inflammation Research, 70712University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden.,Department of Internal Medicine and Clinical Nutrition, 70712University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Priti Gupta
- Department of Rheumatology and Inflammation Research, 70712University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Karin L Gustafsson
- Department of Internal Medicine and Clinical Nutrition, 70712University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Marie K Lagerquist
- Department of Internal Medicine and Clinical Nutrition, 70712University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Hans Carlsten
- Department of Rheumatology and Inflammation Research, 70712University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Ulrika Islander
- Department of Rheumatology and Inflammation Research, 70712University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden.,Department of Internal Medicine and Clinical Nutrition, 70712University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
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Mok CC, Hamijoyo L, Kasitanon N, Chen DY, Chen S, Yamaoka K, Oku K, Li MT, Zamora L, Bae SC, Navarra S, Morand EF, Tanaka Y. The Asia-Pacific League of Associations for Rheumatology consensus statements on the management of systemic lupus erythematosus. THE LANCET. RHEUMATOLOGY 2021; 3:e517-e531. [PMID: 38279404 DOI: 10.1016/s2665-9913(21)00009-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 12/12/2022]
Abstract
Systemic lupus erythematosus (SLE) is prevalent in Asia and carries a variable prognosis among patients across the Asia-Pacific region, which could relate to access to health care, tolerability of medications, and adherence to therapies. Because many aspects of SLE are unique among patients from this region, the Asia-Pacific League of Associations for Rheumatology developed the first set of consensus recommendations on the management of SLE. A core panel of 13 rheumatologists drafted a set of statements through face-to-face meeting and teleconferences. A literature review was done for each statement to grade the quality of evidence and strength of recommendation. 29 independent specialists and three patients with SLE were then recruited for a modified Delphi process to establish consensus on the statements through an online voting platform. A total of 34 consensus recommendations were developed. Panellists agreed that patients with SLE should be referred to a specialist for the formulation of a treatment plan through shared decision making between patients and physicians. Remission was agreed to be the goal of therapy, but when it cannot be achieved, a low disease activity state should be aimed for. Patients should be screened for renal disease, and hydroxychloroquine is recommended for all Asian people with SLE. Major organ manifestations of SLE should be treated with induction immunosuppression and subsequently maintenance; options include cyclophosphamide, mycophenolate mofetil, azathioprine, and calcineurin inhibitors, in combination with glucocorticoids. Biologics, combination regimens, plasma exchange, and intravenous immunoglobulins should be reserved for cases of refractory or life-threatening disease. Anticoagulation therapy with warfarin is preferred to the direct oral anticoagulants for thromboembolic SLE manifestations associated with a high-risk antiphospholipid antibody profile.
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Affiliation(s)
- Chi Chiu Mok
- Division of Rheumatology, Department of Medicine, Tuen Mun Hospital, Hong Kong Special Administrative Region, China.
| | - Laniyati Hamijoyo
- Rheumatology Division, Department of Internal Medicine, Padjadjaran University, Jawa Barat, Indonesia
| | - Nuntana Kasitanon
- Division of Rheumatology, Department of Internal Medicine, Chiang Mai University, Thailand
| | - Der Yuan Chen
- Rheumatology and Immunology Centre, China Medical University, Taichung, Taiwan
| | - Sheng Chen
- Department of Rheumatology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Kunihiro Yamaoka
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Kanagawa, Japan
| | - Kenji Oku
- Department of Rheumatology, Endocrinology and Nephrology Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Meng Tao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China; Chinese Academy of Medical Science, National Clinical Research Centre for Dermatological and Immunological Diseases, Beijing, China
| | - Leonid Zamora
- Section of Rheumatology, University of Santo Tomas, Manila, Philippines
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
| | - Sandra Navarra
- Section of Rheumatology, University of Santo Tomas, Manila, Philippines
| | - Eric F Morand
- Centre for Inflammatory Diseases, Monash University School of Clinical Sciences, Monash Medical Centre, Melbourne, Australia
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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22
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Li L, Xie H, Lu N, Esdaile JM, Aviña-Zubieta JA. Impact of Systemic Lupus Erythematosus on the Risk of Newly Diagnosed Hip Fracture: A General Population-Based Study. Arthritis Care Res (Hoboken) 2021; 73:259-265. [PMID: 31758639 DOI: 10.1002/acr.24112] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 11/19/2019] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Hip fractures have serious consequences, including a 1-year mortality rate of 30%. Population-based studies on hip fractures in individuals with systemic lupus erythematosus (SLE) are scarce. Our objective was to assess the independent risk of hip fractures in patients with newly diagnosed SLE compared to the general population, accounting for baseline and time-varying confounders. METHODS A cohort of all patients with incident SLE who received health care between January 1, 1997 and March 31, 2015 was assembled. The primary outcome was the occurrence of the first hip fracture since the study entry date. Individuals without SLE were randomly selected from the general population and matched (5:1) to those with SLE based on age, sex, and index year. Cumulative incidence was calculated after accounting for competing risks of death. Marginal structural Cox models were used to estimate the impact of SLE on hip fractures, adjusting for baseline and time-dependent covariates (i.e., glucocorticoid use and the number of outpatient, inpatient, and rheumatologist visits). RESULTS Among 5,047 individuals with incident SLE and 25,235 individuals without SLE (86% female, mean age 40 years), we found 73 and 272 hip fractures during 78,915 and 395,427 person-years, respectively. The crude incidence rate ratio was 1.34 (95% confidence interval [95% CI] 1.02-1.75). After adjusting for baseline covariates, the hazard ratio (HR) was 1.86 (95% CI 1.37-2.52). After further adjustment for time-dependent covariates, the HR remained significant at 1.62 (95% CI 1.06-2.48). CONCLUSION Patients with newly diagnosed SLE have a 62% increased risk of hip fractures compared to individuals without SLE. For patients with SLE, this result has important implications for prevention of osteoporosis, which may lead to hip fractures.
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Affiliation(s)
- Lingyi Li
- Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Hui Xie
- Arthritis Research Canada, Richmond, and Simon Fraser University, Burnaby, British Columbia, Canada
| | - Na Lu
- Arthritis Research Canada, Richmond, British Columbia, Canada
| | - John M Esdaile
- Arthritis Research Canada, Richmond, and University of British Columbia, Vancouver, British Columbia, Canada
| | - J Antonio Aviña-Zubieta
- Arthritis Research Canada, Richmond, and University of British Columbia, Vancouver, British Columbia, Canada
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23
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Jung JY, Choi ST, Park SH, Kwon SR, Kim HA, Kim SS, Kim SH, Suh CH. Prevalence of osteoporosis in patients with systemic lupus erythematosus: A multicenter comparative study of the World Health Organization and fracture risk assessment tool criteria. Osteoporos Sarcopenia 2021; 6:173-178. [PMID: 33426305 PMCID: PMC7783110 DOI: 10.1016/j.afos.2020.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/15/2020] [Accepted: 11/02/2020] [Indexed: 01/02/2023] Open
Abstract
Objectives Osteoporosis and fracture are known complications of systemic lupus erythematosus (SLE). We assessed the prevalence and risk factors for osteoporosis in patients with SLE. Methods A total of 155 female SLE patients were recruited retrospectively in 5 university hospitals. The bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry, and the fracture risk assessment tool (FRAX) for high-risk osteoporotic fractures was calculated with and without BMD. Results The mean age was 53.7 ± 6.8 years, and osteoporotic fractures were detected in 19/127 (15.0%) patients. The proportion of patients having a high-risk for osteoporotic fractures in the FRAX with and without BMD, and osteoporosis by the World Health Organization (WHO) criteria were 25 (16.1%), 24 (15.5%), and 51 (32.9%), respectively, and 48.0-68.6% of them were receiving treatment. On multivariate logistic analysis, nephritis (odds ratio [OR] 11.35) and cumulative dose of glucocorticoid (OR 1.1) were associated with high-risk by the FRAX with BMD, and low complement levels (OR 4.38), erythrocyte sedimentation rate (ESR) (OR 1.04), and cumulative dose of glucocorticoid (OR 1.05) were associated with osteoporosis by the WHO criteria in patients with SLE. Conclusions Among Korean female patients with SLE, the proportion of patients having a high-risk of osteoporotic fractures by the FRAX tool was 15.5%-16.1% and the proportion of patients having osteoporosis by the WHO criteria was 32.9%. In SLE, nephritis, low level of complement, ESR, and cumulative dose of glucocorticoids may contribute to fracture risk.
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Affiliation(s)
- Ju-Yang Jung
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Sang Tae Choi
- Division of Rheumatology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Sung-Hoon Park
- Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Seong-Ryul Kwon
- Division of Rheumatology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Hyoun-Ah Kim
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Sung-Soo Kim
- Division of Rheumatology, Department of Internal Medicine, Ulsan University College of Medicine, Gangneung Asan Hospital, Gangneung, Republic of Korea
| | - Sang Hyon Kim
- Division of Rheumatology, Department of Internal Medicine, Keimyung University College of Medicine, Daegu, Republic of Korea
| | - Chang-Hee Suh
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Republic of Korea
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24
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Boone JB, Wheless L, Camai A, Tanner SB, Barnado A. Low prevalence of bone mineral density testing in patients with systemic lupus erythematosus and glucocorticoid exposure. Lupus 2020; 30:403-411. [PMID: 33307984 DOI: 10.1177/0961203320979735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
SummaryPatients with systemic lupus erythematosus (SLE) have an increased risk of developing osteoporosis and fractures due to systemic inflammation and glucocorticoids (GCs). Professional organizations recommend bone mineral density (BMD) testing in SLE patients on GCs, especially within 6 months of initiation. Using a validated algorithm, we identified SLE patients in an electronic health record cohort with long-term GC exposure (≥90 days). Our primary outcome was ever BMD testing. We assessed the impact of patient and provider factors on testing. We identified 693 SLE cases with long-term GC exposure, 41% of whom had BMD testing performed. Only 18% of patients had BMD testing within 6 months of GC initiation. In a logistic regression model for BMD testing, male sex (OR = 0.49, 95% CI 0.27 - 0.87, p = 0.01) was associated with being less likely to have BMD testing after adjusting for race and ethnicity. In contrast, older age (OR = 1.04, p < 0.001) and nephritis (OR = 1.83, p = 0.003) were associated with being more likely to have BMD testing after adjusting for race and ethnicity. Bone health in SLE patients remains an area in need of improvement with attention to patients who are younger and male.
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Affiliation(s)
- J B Boone
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lee Wheless
- Department of Dermatology, Data Science Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alex Camai
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - S Bobo Tanner
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - April Barnado
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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25
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Ruaro B, Casabella A, Paolino S, Alessandri E, Patané M, Gotelli E, Sulli A, Cutolo M. Trabecular Bone Score and Bone Quality in Systemic Lupus Erythematosus Patients. Front Med (Lausanne) 2020; 7:574842. [PMID: 33102506 PMCID: PMC7554588 DOI: 10.3389/fmed.2020.574842] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 08/14/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Systemic lupus erythematosus (SLE) patients run a higher risk of having low bone mass due to multifactorial events that include physical inactivity, persistent inflammation, low vitamin D levels, and glucocorticoid treatment. This study aimed at obtaining a comparison between bone involvement in SLE patients and healthy matched subjects (HS). Methods: A total of 40 SLE females (average age 54.1 ± 16.3 years) and 40 age–gender matched HS (average age 54.2 ± 15.9 years) were enrolled after having obtained informed written consent. Bone mineral density (BMD, g/cm2) of the lumbar spine (L1–L4) was analyzed by a dual-energy X-ray absorptiometry (DXA) scan (GE, Lunar Prodigy). The lumbar spine trabecular bone score (TBS) was derived for each spine DXA examination by the TBS index (TBS iNsight Medimaps). Results: The lumbar spine TBS score was statistically significantly lower in SLE patients than in HS (0.797 ± 0.825 vs. 1.398 ± 0.207, p < 0.001, as was BMD (p < 0.001) in all areas examined. Conclusions: SLE is associated with significant low bone mass as evidenced by DXA and TBS. This study emphasizes the importance of using DXA and TBS in the evaluation of the different aspects of bone architecture.
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Affiliation(s)
- Barbara Ruaro
- Pulmonology Department, University Hospital of Trieste, Trieste, Italy
| | - Andrea Casabella
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine (Di.M.I.), IRCCS San Martino Polyclinic Hospital, University of Genova, Genoa, Italy.,Osteoporosis, Bone and Joint Disease Research Center, CROPO, Department of Internal Medicine Di.M.I., University of Genoa, Genoa, Italy
| | - Sabrina Paolino
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine (Di.M.I.), IRCCS San Martino Polyclinic Hospital, University of Genova, Genoa, Italy.,Osteoporosis, Bone and Joint Disease Research Center, CROPO, Department of Internal Medicine Di.M.I., University of Genoa, Genoa, Italy
| | - Elisa Alessandri
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine (Di.M.I.), IRCCS San Martino Polyclinic Hospital, University of Genova, Genoa, Italy
| | - Massimo Patané
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine (Di.M.I.), IRCCS San Martino Polyclinic Hospital, University of Genova, Genoa, Italy
| | - Emanuele Gotelli
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine (Di.M.I.), IRCCS San Martino Polyclinic Hospital, University of Genova, Genoa, Italy.,Lupus Clinic, Department of Internal Medicine (Di.M.I.), IRCCS San Martino Polyclinic Hospital, University of Genova, Genoa, Italy
| | - Alberto Sulli
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine (Di.M.I.), IRCCS San Martino Polyclinic Hospital, University of Genova, Genoa, Italy.,Lupus Clinic, Department of Internal Medicine (Di.M.I.), IRCCS San Martino Polyclinic Hospital, University of Genova, Genoa, Italy
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine (Di.M.I.), IRCCS San Martino Polyclinic Hospital, University of Genova, Genoa, Italy
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26
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Chen J, Lei L, Pan J, Zhao C. A meta-analysis of fracture risk and bone mineral density in patients with systemic sclerosis. Clin Rheumatol 2019; 39:1181-1189. [PMID: 31838641 DOI: 10.1007/s10067-019-04847-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/16/2019] [Accepted: 11/04/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Osteoporosis and fractures are important public health issues that impose serious burdens on patients. Patients with systemic sclerosis (SSc) have low bone mineral density (BMD) and increased risk for fracture. We aimed to explore the association between SSc and BMD and fracture risk. METHODS For this meta-analysis, we analyzed data from articles that reported mean differences in BMD or fracture risk between patients with SSc and controls. We undertook a systematic literature search of the PubMed, Web of Science, and Cochrane Library databases. The pooled weighted mean difference (WMD) was used to estimate the mean difference in BMD between patients with SSc and controls. Pooled odds ratios (ORs; with 95% confidence intervals [95% CIs]) were used to assess the association between SSc and fracture risk. RESULTS Analysis of the results from 18 studies showed that patients with SSc had significantly lower BMD than controls in the following categories: whole body (WMD - 0.07, 95% CI - 0.1 to - 0.04, p < 0.00001), lumbar spine (WMD - 0.08, 95% CI - 0.11 to - 0.05, p < 0.00001), femoral neck (WMD: -0.28, 95% CI: -0.46 to -0.10, p=0.002), total hip (WMD - 0.10, 95% CI - 0.14 to - 0.06, p < 0.00001), and femoral trochanter (WMD - 0.06, 95% CI - 0.09 to - 0.03, p < 0.0001). Moreover, patients with SSc had an increased risk of vertebral fracture (OR 10.38, 95% CI 1.19 to 90.58, p = 0.03). We did not find a significant difference in the risk of osteoporotic fracture between patients with SSc and controls (OR = 2.24, 95% CI 0.58 to 8.59, p = 0.24). CONCLUSION Patients with SSc have a significant reduction in bone mass, and these patients have an increased risk of vertebral fracture. The early monitoring of BMD in patients with SSc is recommended for the prevention of osteoporosis and fracture.Key points• SSc patients have a significant low BMD• SSc patients also have an increased risk of vertebral fracture.
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Affiliation(s)
- Juan Chen
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530000, Guangxi Province, China
| | - Ling Lei
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530000, Guangxi Province, China.
| | - Jie Pan
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530000, Guangxi Province, China
| | - Cheng Zhao
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530000, Guangxi Province, China
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27
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Nordqvist J, Lagerquist MK, Grahnemo L, Koskela A, Islander U, Carlsten H. Osteoporosis in a murine model of postmenopausal lupus. Lupus 2019; 29:58-66. [PMID: 31825765 DOI: 10.1177/0961203319893759] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND/OBJECTIVE Postmenopausal women with systemic lupus erythematosus have an increased risk of osteoporosis and associated fractures. Their increased osteoporosis risk is probably caused by a high level of inflammation, use of glucocorticoids, impaired kidney function, and early menopause as these are known risk factors for osteoporosis. Due to these risk factors and the lack of safe and effective treatments, new therapies for the treatment of osteoporosis in this group of patients are needed. Ovariectomized MRL/lpr mice constitute a well-established model for studies of postmenopausal systemic lupus erythematosus; however, it is not clear to what extent this experimental model is associated with the development of osteoporosis. Thus, the aim of this study was to characterize the skeleton of ovariectomized MRL/lpr mice to determine the suitability of this model in studies of prospective new therapies for osteoporosis in postmenopausal systemic lupus erythematosus patients. METHODS Skeletal parameters were measured in MRL/lpr mice and MRL/++ control mice, using peripheral quantitative computed tomography, high-resolution micro-computed tomography and biomechanical analyses. mRNA expression of bone-remodeling markers was measured by quantitative polymerase chain reaction and serological markers of lupus disease were evaluated using ELISA. RESULTS Total bone mineral density was reduced in MRL/lpr mice compared with MRL/++ mice and MRL/lpr mice had reduced cortical and trabecular bone thickness compared with MRL/++ mice. In line with the low bone mass of MRL/lpr mice, gene expression analysis of cortical bone from these mice indicated an increased osteoclast activity as well as a decreased osteoblastogenesis and osteoblast activity, compared with MRL/++ mice. CONCLUSION Ovariectomized MRL/lpr mice constitute a valuable experimental model for studies of osteoporosis development in postmenopausal systemic lupus erythematosus and this model is thus suitable for future studies of osteoporosis treatment in systemic lupus erythematosus.
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Affiliation(s)
- J Nordqvist
- Department of Rheumatology and Inflammation Research, Centre for Bone and Arthritis Research, University of Gothenburg, Sweden
| | - M K Lagerquist
- Department of Internal Medicine and Clinical Nutrition, Centre for Bone and Arthritis Research, University of Gothenburg, Sweden
| | - L Grahnemo
- Department of Internal Medicine and Clinical Nutrition, Centre for Bone and Arthritis Research, University of Gothenburg, Sweden
| | - A Koskela
- Department of Anatomy and Cell Biology, University of Oulu, Finland
| | - U Islander
- Department of Internal Medicine and Clinical Nutrition, Centre for Bone and Arthritis Research, University of Gothenburg, Sweden
| | - H Carlsten
- Department of Rheumatology and Inflammation Research, Centre for Bone and Arthritis Research, University of Gothenburg, Sweden
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28
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Adami G, Fassio A, Rossini M, Caimmi C, Giollo A, Orsolini G, Viapiana O, Gatti D. Osteoporosis in Rheumatic Diseases. Int J Mol Sci 2019; 20:E5867. [PMID: 31766755 PMCID: PMC6928928 DOI: 10.3390/ijms20235867] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/16/2019] [Accepted: 11/21/2019] [Indexed: 12/17/2022] Open
Abstract
Osteoporosis is a chronic disease characterized by an increased risk of fragility fracture. Patients affected by rheumatic diseases are at greater risk of developing osteoporosis. The purpose of the present review is to discuss the pathogenesis, epidemiology, and treatment of osteoporosis in patients affected by rheumatic diseases with special focus for rheumatoid arthritis, psoriatic arthritis, spondyloarthritis, systemic lupus erythematosus, systemic sclerosis, vasculitides, Sjogren syndrome, and crystal-induced arthritis.
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Affiliation(s)
- Giovanni Adami
- Rheumatology Unit, University of Verona, Policlinico Borgo Roma, Pz Scuro 10, 37134 Verona, Italy; (A.F.); (M.R.); (C.C.); (A.G.); (G.O.); (O.V.); (D.G.)
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Abstract
Estrogen has been known for a long time to be a trigger on auto-immunity and may influence the course of lupus. Women experiencing systemic lupus are at high risk for premature ovarian insufficiency if using cyclophosphamide, of osteoporosis, arterial ischemic diseases and venous thrombosis at young age. In about 30% of them, an antiphospholipid/anticoagulant antibody can occur which is associated with very high risk of thrombosis. However, the severity of the disease may vary and some women with lupus could benefit from a menopausal hormone therapy (MHT). As a consequence, management of menopause symptoms needs to evaluate carefully the condition of the patient, her lupus history and cardiovascular risk. We will describe the effect of lupus on menopause, of menopause on lupus and report in detail the literature available on MHT and the risk of lupus or the risk of flares in women with lupus. Some other options than MHT for the management of climacteric symptoms will be discussed.
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Affiliation(s)
- A Gompel
- Gynaecological Endocrinology Unit, Paris Descartes University, Paris, France
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30
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Naranjo Hernández A, Díaz del Campo Fontecha P, Aguado Acín MP, Arboleya Rodríguez L, Casado Burgos E, Castañeda S, Fiter Aresté J, Gifre L, Gómez Vaquero C, Candelas Rodríguez G, Francisco Hernández FM, Guañabens Gay N. Recomendaciones de la Sociedad Española de Reumatología sobre osteoporosis. ACTA ACUST UNITED AC 2019; 15:188-210. [DOI: 10.1016/j.reuma.2018.09.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/17/2018] [Accepted: 09/19/2018] [Indexed: 01/09/2023]
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31
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Lai EL, Huang WN, Chen HH, Hsu CY, Chen DY, Hsieh TY, Hung WT, Lin CT, Lai KL, Tang KT, Chen YM, Chen YH. Ten-year fracture risk by FRAX and osteoporotic fractures in patients with systemic autoimmune diseases. Lupus 2019; 28:945-953. [PMID: 31177913 DOI: 10.1177/0961203319855122] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The Fracture Risk Assessment Tool (FRAX) has been used universally for the purpose of fracture risk assessment. However, the predictive capacity of FRAX for autoimmune diseases remains inconclusive. This study aimed to compare the applicability of FRAX for autoimmune disease patients. This retrospective study recruited rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and primary Sjögren syndrome (pSS) patients with bone mineral density (BMD) tests. Patients with any osteoporotic fractures were identified. Taiwan-specific FRAX with and without BMD were then calculated. In total, 802 patients (451 RA, 233 SLE and 118 pSS) were enrolled in this study. The cumulative incidences of osteoporotic fractures in the RA, SLE and pSS patients were 43.0%, 29.2% and 33.1%, respectively. For those with a previous osteoporotic fracture, T-scores were classified as low bone mass. Overall, the patients' 10-year probability of major fracture risk by FRAX without BMD was 15.8%, which then increased to 20.3% after incorporation of BMD measurement. When analyzed by disease group, the fracture risk in RA patients was accurately predicted by FRAX. In contrast, current FRAX, either with or without BMD measurement, underestimated the fracture risk both in SLE and pSS patients, even after stratification by age and glucocorticoid treatment. For pSS patients with major osteoporotic fractures, FRAX risks imputed by RA were comparable to major osteoporotic fracture risks of RA patients. Current FRAX accurately predicted fracture probability in RA patients, but not in SLE and pSS patients. RA-imputed FRAX risk scores could be used as a temporary substitute for SLE and pSS patients.
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Affiliation(s)
- E-L Lai
- 1 Rheumatology Unit, Department of Internal Medicine, Hospital Sultan Ismail, Johor Bahru, Malaysia.,2 Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - W-N Huang
- 2 Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,3 Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - H-H Chen
- 2 Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,3 Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,4 Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.,5 Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, Chung Hsing University, Taichung, Taiwan
| | - C-Y Hsu
- 4 Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - D-Y Chen
- 6 Rheumatology and Immunology Center, Department of Medicine, China Medical University Hospital, Taichung, Taiwan
| | - T-Y Hsieh
- 2 Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,7 Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan
| | - W-T Hung
- 2 Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,3 Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - C-T Lin
- 2 Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - K-L Lai
- 2 Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - K-T Tang
- 2 Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Y-M Chen
- 2 Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,3 Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,4 Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.,5 Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, Chung Hsing University, Taichung, Taiwan
| | - Y-H Chen
- 2 Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,3 Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
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Felten R, Sagez F, Gavand PE, Martin T, Korganow AS, Sordet C, Javier RM, Soulas-Sprauel P, Rivière M, Scher F, Poindron V, Guffroy A, Arnaud L. 10 most important contemporary challenges in the management of SLE. Lupus Sci Med 2019; 6:e000303. [PMID: 30729019 PMCID: PMC6340557 DOI: 10.1136/lupus-2018-000303] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/12/2018] [Accepted: 12/16/2018] [Indexed: 01/05/2023]
Abstract
From a 1-year survival of less than 50% before the discovery of glucocorticoids to over 90% at 10 years in most dedicated centres, the spectrum of SLE has profoundly evolved. Despite this improvement, several major challenges currently remain. The aim of this review is to analyse what are, according to us, the 10 most important contemporary challenges in the management of SLE. Among those are the need to treat to target to favour disease remission (or low disease activity), limit the use of glucocorticoids, derive more comprehensive tools for the evaluation of disease activity, develop more effective drugs (yielding successful trials), dissect the heterogeneity of the disease both at the molecular and genetic levels, identify relevant biomarkers for individualised treatment, manage fertility and pregnancy, tackle comorbidities such as cardiovascular risk, the prevention of infections and osteoporosis, improve the network of care (from the patients’ perspective), and favour a holistic approach (integrating fatigue, adherence to treatment, physical activity). Altogether, these 10 contemporary challenges in SLE may be considered as a roadmap for those involved in the daily care of patients with SLE, as well as for researchers who may wish to contribute to an improved management of this rare and complex disease.
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Affiliation(s)
- Renaud Felten
- Service de rhumatologie, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.,Centre National de Références des Maladies Systémiques et Autoimmunes Rares Est Sud-Ouest (RESO)-LUPUS, Strasbourg, France
| | - Flora Sagez
- Service de rhumatologie, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.,Centre National de Références des Maladies Systémiques et Autoimmunes Rares Est Sud-Ouest (RESO)-LUPUS, Strasbourg, France
| | - Pierre-Edouard Gavand
- Centre National de Références des Maladies Systémiques et Autoimmunes Rares Est Sud-Ouest (RESO)-LUPUS, Strasbourg, France.,Service d'immunologie clinique, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Thierry Martin
- Centre National de Références des Maladies Systémiques et Autoimmunes Rares Est Sud-Ouest (RESO)-LUPUS, Strasbourg, France.,Service d'immunologie clinique, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Anne-Sophie Korganow
- Centre National de Références des Maladies Systémiques et Autoimmunes Rares Est Sud-Ouest (RESO)-LUPUS, Strasbourg, France.,Service d'immunologie clinique, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Christelle Sordet
- Service de rhumatologie, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.,Centre National de Références des Maladies Systémiques et Autoimmunes Rares Est Sud-Ouest (RESO)-LUPUS, Strasbourg, France
| | - Rose-Marie Javier
- Service de rhumatologie, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.,Centre National de Références des Maladies Systémiques et Autoimmunes Rares Est Sud-Ouest (RESO)-LUPUS, Strasbourg, France
| | - Pauline Soulas-Sprauel
- Centre National de Références des Maladies Systémiques et Autoimmunes Rares Est Sud-Ouest (RESO)-LUPUS, Strasbourg, France.,Service d'immunologie clinique, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Marianne Rivière
- Association Française du Lupus et autres Maladies Auto-Immunes (AFL+), France
| | - Florence Scher
- Service de Pharmacie-Stérilisation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Vincent Poindron
- Centre National de Références des Maladies Systémiques et Autoimmunes Rares Est Sud-Ouest (RESO)-LUPUS, Strasbourg, France.,Service d'immunologie clinique, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Aurélien Guffroy
- Centre National de Références des Maladies Systémiques et Autoimmunes Rares Est Sud-Ouest (RESO)-LUPUS, Strasbourg, France.,Service d'immunologie clinique, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Laurent Arnaud
- Service de rhumatologie, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.,Centre National de Références des Maladies Systémiques et Autoimmunes Rares Est Sud-Ouest (RESO)-LUPUS, Strasbourg, France
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van Niekerk G, Mitchell M, Engelbrecht AM. Bone resorption: supporting immunometabolism. Biol Lett 2018; 14:rsbl.2017.0783. [PMID: 29491030 DOI: 10.1098/rsbl.2017.0783] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/01/2018] [Indexed: 12/21/2022] Open
Abstract
Activation of the immune system is associated with an increase in the breakdown of various peripheral tissues, including bone. Despite the widely appreciated role of inflammatory mediators in promoting bone resorption, the functional value behind this process is not completely understood. Recent advances in the field of immunometabolism have highlighted the metabolic reprogramming that takes place in activated immune cells. It is now believed that the breakdown of peripheral tissue provides metabolic substrates to fuel metabolic anabolism in activated immune cells. We argue that phosphate, liberated by bone resorption, plays an indispensable role in sustaining immune cell metabolism. The liberated phosphate is then incorporated into macromolecules such as nucleotides and phospholipids, and is also used for the phosphorylation of metabolites (e.g. glycolytic intermediates). In addition, magnesium, also liberated during the breakdown of bone, is an essential cofactor required by various metabolic enzymes which are upregulated in activated immune cells. Finally, calcium activates various additional molecules involved in immune cell migration. Taken together, these factors suggest a key role for bone resorption during infection.
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Affiliation(s)
- Gustav van Niekerk
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Megan Mitchell
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Anna-Mart Engelbrecht
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
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Sarkissian A, Sivaraman V, Bout-Tabaku S, Ardoin SP, Moore-Clingenpeel M, Mruk V, Steigelman H, Morris K, Bowden SA. Bone turnover markers in relation to vitamin D status and disease activity in adults with systemic lupus erythematosus. Lupus 2018; 28:156-162. [PMID: 30509154 DOI: 10.1177/0961203318815593] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Patients with systemic lupus erythematosus (SLE) have altered bone metabolism and are at risk of osteoporosis. The aim of this study was to examine bone turnover markers in relation to vitamin D, disease activity, and clinical risk factors in patients with established SLE. METHODS Clinical registry and biorepository data of 42 SLE patients were assessed. Serum samples were analyzed for osteocalcin as a marker of bone formation, C-terminal telopeptide of type 1 collagen (CTX) as a marker for bone resorption, and 25-hydroxy vitamin D. RESULTS Patients with a Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI) score of 3 or greater had a lower median osteocalcin level ( P = 0.02) and lower 25-hydroxy vitamin D levels ( P = 0.03) than those with a score of less than 3. No significant differences in bone turnover markers were observed between patients dichotomized into subgroups using a 25-hydroxy vitamin D cut-off of 30 ng/mL or by a daily prednisone dose greater than or 5 mg or less. Osteocalcin levels were negatively correlated with SLEDAI scores ( P = 0.034), and were positively correlated with the CTX index (a ratio of measured CTX value to the upper limit of the normal value for age and gender) ( P < 0.01). No association between the CTX index and SLEDAI scores was found. CONCLUSION SLE disease activity may have direct effects on bone formation, but no effects on bone resorption in this cohort of established SLE patients, probably related to the inflammation-suppressing effects of glucocorticoids, thereby inhibiting cytokine-induced osteoclast activity. A fine balance exists between disease control and the use of glucocorticoids with regard to bone health.
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Affiliation(s)
- A Sarkissian
- 1 Pediatric Rheumatology, Nationwide Children's Hospital and The Ohio State University Medical Center, Columbus, USA
| | - V Sivaraman
- 1 Pediatric Rheumatology, Nationwide Children's Hospital and The Ohio State University Medical Center, Columbus, USA
| | - S Bout-Tabaku
- 2 Pediatric Rheumatology, Sidra Medicine, Doha, Qatar
| | - S P Ardoin
- 1 Pediatric Rheumatology, Nationwide Children's Hospital and The Ohio State University Medical Center, Columbus, USA
| | | | - V Mruk
- 1 Pediatric Rheumatology, Nationwide Children's Hospital and The Ohio State University Medical Center, Columbus, USA
| | - H Steigelman
- 4 Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, USA
| | - K Morris
- 4 Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, USA
| | - S A Bowden
- 5 Pediatric Endocrinology, Nationwide Children's Hospital and The Ohio State University Medical Center, Columbus, USA
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Mendoza-Pinto C, Rojas-Villarraga A, Molano-González N, Jiménez-Herrera EA, León-Vázquez MDLL, Montiel-Jarquín Á, García-Carrasco M, Cervera R. Bone mineral density and vertebral fractures in patients with systemic lupus erythematosus: A systematic review and meta-regression. PLoS One 2018; 13:e0196113. [PMID: 29897913 PMCID: PMC5999233 DOI: 10.1371/journal.pone.0196113] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 04/08/2018] [Indexed: 12/04/2022] Open
Abstract
Background Observational studies have indicated a high but heterogeneous prevalence of low bone mineral density (BMD) and vertebral fractures (VF) in patients with systemic lupus erythematosus (SLE). Therefore, the objectives of this systematic review and meta-regression were: 1) to compare BMD between SLE patients and healthy controls and 2) to evaluate the relationship between BMD and glucocorticoid therapy and VF in SLE patients. Methods and findings Articles were identified from electronic databases (PubMed, Embase, VHL, SciELO and the Cochrane Library). Prospective longitudinal and cross-sectional studies were considered for review. We evaluated the quality of the evidence included using the Oxford Centre for evidence-based medicine (EBM) Levels of Evidence. In total, 38 articles were identified and analyzed (3442 SLE cases and 6198 controls) in the analysis of BMD (9232 women and 408 men). There were significant differences in mean BMD between SLE patients and controls. BMD mean difference in cases/controls: -0.0566 95% CI (-0.071, -0.0439; p = < 0.0001). When only SLE patients were analyzed, the BMD did not significantly differ between patients who had or had not received glucocorticoid (GCT) therapy. 694 SLE patients were included in the analysis of VF (189 with VF vs. 505 without VF). Patients with VF had lower BMD than patients without VF (BMD mean difference without VF/with VF: 0.033 (95%CI: 0.006–0.060); p-value: 0.0156). Conclusions Patients with SLE had lower BMD than healthy controls. Moreover, SLE patients with VF had lower BMD than patients without VF. However, our data did not show that GCT therapy had an impact on BMD.
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Affiliation(s)
- Claudia Mendoza-Pinto
- Systemic Autoimmune Diseases Research Unit, Hospital de Especialidades, UMAE CMNMAC—CIBIOR, Instituto Mexicano del Seguro Social, Puebla, Puebla, México
- Department of Immunology and Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, Puebla, México
| | | | - Nicolás Molano-González
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Erick A. Jiménez-Herrera
- Systemic Autoimmune Diseases Research Unit, Hospital de Especialidades, UMAE CMNMAC—CIBIOR, Instituto Mexicano del Seguro Social, Puebla, Puebla, México
| | - María de la Luz León-Vázquez
- Systemic Autoimmune Diseases Research Unit, Hospital de Especialidades, UMAE CMNMAC—CIBIOR, Instituto Mexicano del Seguro Social, Puebla, Puebla, México
| | - Álvaro Montiel-Jarquín
- Research in Health Unit, UMAE, Instituto Mexicano del Seguro Social, México, Puebla, Puebla, México
| | - Mario García-Carrasco
- Systemic Autoimmune Diseases Research Unit, Hospital de Especialidades, UMAE CMNMAC—CIBIOR, Instituto Mexicano del Seguro Social, Puebla, Puebla, México
- Department of Immunology and Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, Puebla, México
- * E-mail:
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Catalonia, Spain
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Bultink IEM. Bone Disease in Connective Tissue Disease/Systemic Lupus Erythematosus. Calcif Tissue Int 2018; 102:575-591. [PMID: 28900675 PMCID: PMC5904226 DOI: 10.1007/s00223-017-0322-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 09/05/2017] [Indexed: 01/07/2023]
Abstract
This article reviews recent advances in the research of the mechanisms of bone loss, as well as clinical features, economic impact and therapeutic implications of osteoporosis and fractures in patients with systemic lupus erythematosus (SLE) as an illustration of bone disease in a complex systemic autoimmune connective tissue disease. Recent studies demonstrated an increased incidence of osteoporosis and peripheral and vertebral fractures in patients with SLE. The aetiology of bone loss in SLE is multifactorial, including clinical osteoporosis risk factors, systemic inflammation, serological factors, metabolic factors, hormonal factors, possibly genetic factors and medication-induced adverse effects. The incidence of symptomatic fractures in patients with SLE is increased 1.2-4.7-fold and age, disease duration, glucocorticoid use, previous cyclophosphamide use, seizures and a prior cerebrovascular event have been identified as important risk factors. Moreover, a high prevalence of morphometric vertebral fractures was demonstrated, while one in three of these patients has normal bone density, which finding points to the multifactorial aetiology of fractures in SLE. The clinical consequences and economic burden of osteoporosis and fractures as glucocorticoid treatment-related adverse events and the high frequency of glucocorticoid therapy underline the importance of reducing glucocorticoid treatment and prescribing steroid-sparing agents. No data on fall risk and its determinants and the relationship with the occurrence of fractures in patients with SLE are currently available. Fall risk might be increased in lupus patients for several reasons. In addition, the recently reported high prevalence (20%) of frailty in SLE patients may contribute to the increased fracture incidence. Therefore, the relationships between fall risk, frailty and fracture occurrence in SLE might be interesting subjects for future studies.
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Affiliation(s)
- Irene E M Bultink
- Department of Rheumatology, Amsterdam Rheumatology and immunology Center, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
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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.
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Affiliation(s)
- M Dey
- University Hospitals of Morecambe Bay NHS Foundation Trust, Royal Lancaster Infirmary, Lancaster, UK
| | - M Bukhari
- University Hospitals of Morecambe Bay NHS Foundation Trust, Royal Lancaster Infirmary, Lancaster, UK
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Hafez EA, ElBakry SA, Ibrahim SI, Morad CS, Hamza SA, Abd El-Khalik DM. Assessment of fracture risk in a cohort of Egyptian female Systemic Lupus erythematosus patients. THE EGYPTIAN RHEUMATOLOGIST 2018; 40:85-91. [DOI: 10.1016/j.ejr.2017.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Salman-Monte TC, Torrente-Segarra V, Vega-Vidal AL, Corzo P, Castro-Dominguez F, Ojeda F, Carbonell-Abelló J. Bone mineral density and vitamin D status in systemic lupus erythematosus (SLE): A systematic review. Autoimmun Rev 2017; 16:1155-1159. [DOI: 10.1016/j.autrev.2017.09.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Abstract
PURPOSE OF REVIEW The article reviews recent advances in the research of fractures in patients with systemic lupus erythematosus (SLE), highlighting their clinical, scientific, and economic impact. RECENT FINDINGS Recent studies demonstrated an increased incidence of osteoporosis and symptomatic fractures in patients with SLE and age, disease duration, disease severity, and glucocorticoid use are important risk factors. A high prevalence of vertebral fractures was demonstrated, while one in three of these patients has normal bone density, which illustrates the multifactorial cause of fractures in SLE. Screening for vertebral fractures is important, as they often occur asymptomatically, but are associated with a reduced quality of life, increased future fracture risk, an increased mortality risk, and may have therapeutic implications. A recently developed Delphi consensus revealed the high economic burden of fractures as a glucocorticoid-related adverse event in SLE, whereas the majority of patients use glucocorticoids. SUMMARY Recent studies revealed an increased incidence of symptomatic fractures and a relatively high prevalence of vertebral fractures in patients with SLE, and provided new insights into their multifactorial aetiology. The clinical consequences and high economic burden of fractures as glucocorticoid-related adverse events underline the importance of reducing glucocorticoid therapy and use of steroid-sparing agents.
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Golder V, Hoi A. Systemic lupus erythematosus: an update. Med J Aust 2017; 206:215-220. [PMID: 28301792 DOI: 10.5694/mja16.01229] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 12/12/2016] [Indexed: 12/25/2022]
Abstract
Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease predominantly affecting women of childbearing age. New classification criteria for SLE have greater sensitivity and therefore improve the diagnostic certainty for some patients, especially those who may previously have been labelled as having undifferentiated symptoms. Uncontrolled disease activity leads to irreversible end-organ damage, which in turn increases the risk of premature death; early and sustained control of disease activity can usually be achieved by conventional immunosuppressant therapy. The development of biological therapy lags behind that for other rheumatic diseases, with belimumab being the only targeted therapy approved by the Therapeutic Goods Administration. "Treat-to-target" concepts are changing trial design and clinical practice, with evidence-based definition of response criteria in the form of remission and low disease activity now on the horizon. While new therapies are awaited, research should also focus on optimising the use of current therapy and improving the quality of care of patients with SLE.
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