Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.

Increased Risk of Osteoporosis and Fracture in Patients with Systemic Sclerosis. A Comparison to Rheumatoid Arthritis.

Avouac,  Jérôme, Koumakis,  Eugénie, Toth,  Emese, Meunier,  Marine, Maury,  Emilie, Cormier,  Catherine, Kahan,  Andre


To investigate whether patients with systemic sclerosis (SSc) have increased risk of osteoporosis (OP) and fractures compared to a "high risk" population with rheumatoid arthritis (RA)


Cross-sectional study with successive inclusion of SSc and RA patients matched for age and sex on a 12-month period. Risk factors for OP and fractures, including age, menopausal status, calcium/vitamin D intake, family history, comorbidity and steroid use, were collected for all patients. Bone mineral density (BMD) was assessed at AP lumbar spine (L1-L4), femoral neck, and total hip region with DXA Prodigy (GE-Lunar) or QDR4500 (Hologic). We included 75 successive patients with SSc (70 women, 93%) and 147 (139 women, 94%) with RA. The mean ± standard deviation, SD, age of SSc patients was 62±12 years; the mean ± SD disease duration was 10±9 years; 52 (69%) had the limited cutaneous subset and 23 (31%) the diffuse. The mean ± SD age of RA patients was 61±11 years and their mean ± SD disease duration was 18±13 years. RA Patients were more likely to receive corticosteroids than SSc patients (137 (93%) vs. 45 (60%), p<0.0001). Cumulative dose of corticosteroids and CRP were significantly higher in patients with RA than SSc (39554±29661 mg vs. 19392±19333 mg, p<0.0001 and 12±16 mg/l vs. 7±7.9 mg/l, p=0.01).


The point prevalence of OP (T-score <-2.5) was 28% and 32% in SSc and RA, respectively (p=NS). Bone mineral density measured on lumbar spine, femoral neck and total hip was not different between SSc and RA patients. The point prevalence of fractures was 33% and 32% in SSc and RA, respectively (p=NS). The frequency of vertebral (24% vs. 17%) and non-vertebral fracture (23% vs. 21%) did not differ between the two groups. In multivariate logistic regression analysis, patients with SSc and OP (n=21) were more likely to have longer disease duration than patients without osteoporosis (odds ratio, OR: 1.11, 95% confidence interval, CI: 1.03–1.21). There was no association between OP and treatment with corticosteroid, systemic inflammation (CRP >10mg/l) or any SSc feature. In multivariate analysis, patients with SSc and fractures (n=25) were more likely to be older (OR: 1.10, 95% CI 1.03–1.18) and to have vitamin D deficiency (OR: 95% CI: 5.04 1.27–20.02). In comparison, patients with RA and OP (n=47) were more likely to be older (OR: 1.04, 95% CI: 1.01–1.09) and treated with corticosteroids than patients without OP (OR: 3.30, 95% CI: 1.02–10.70). Cumulative dose of corticosteroids negatively correlated with BMD measured at lumbar spine (r=0.38, p=0.01) and total hip (r=0.49, p=0.008) in RA patients. In addition, age (OR: 1.07, 95% CI: 1.02–1.12) and vitamin D deficiency (OR: 4.97, 95% CI: 1.53–16.13) were associated with fractures in RA patients.


The prevalence of OP and fracture in SSc patients was comparable to those with RA, highlighting an increased risk of OP and fracture. Age and vitamin D deficiency were found to be important factors. Our results indicated that BMD in SSc was similar to patients with RA. Increasing the awareness to perform BMD measurements and supply vitamin D in patients with SSc may be warranted based on our results, especially for older patients.

To cite this abstract, please use the following information:
Avouac, Jérôme, Koumakis, Eugénie, Toth, Emese, Meunier, Marine, Maury, Emilie, Cormier, Catherine, et al; Increased Risk of Osteoporosis and Fracture in Patients with Systemic Sclerosis. A Comparison to Rheumatoid Arthritis. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :670

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