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

Background/Purpose:

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)

Methods:

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).

Results:

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.

Conclusion:

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
DOI:

Abstract Supplement

Meeting Menu

2011 ACR/ARHP