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Patt YS, Ben-Shabat N, Fisher L, Sharif K, Arow M, Lassman S, Watad A, Skuja V, Shtewe AH, McGonagle D, Amital H. Increased risk of osteoporosis and femoral neck fractures in patients with familial Mediterranean fever-a large retrospective cohort study. Rheumatology (Oxford) 2024; 63:2128-2134. [PMID: 37769238 DOI: 10.1093/rheumatology/kead526] [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: 06/26/2023] [Revised: 08/21/2023] [Accepted: 09/21/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVES The direct impact of inflammatory conditions and their therapy with corticosteroids contribute to an increased risk of osteoporosis with associated fractures. Familial Mediterranean fever (FMF) is an autoinflammatory disorder not commonly treated with corticosteroids. Evidence regarding FMF association with osteoporosis and femur fractures is anecdotal. We aimed to evaluate the incidence and risk of osteoporosis and femoral neck fracture in FMF patients compared with the general population. METHODS A retrospective cohort study using the electronic database of Clalit Health Services of all FMF patients first diagnosed between 2000 and 2016 and controls was conducted including age- and sex-matched controls in a 1:1 ratio. Follow-up continued until the first diagnosis of osteoporosis or fracture. Risk for these conditions was compared using univariate and multivariate Cox regression models. RESULTS A total of 9769 FMF patients were followed for a median period of 12.5 years. Of these, 304 FMF patients were diagnosed with osteoporosis compared with 191 controls, resulting in an incidence rate (per 10 000 persons-years) of 28.8 and 17.8, respectively, and a crude hazard ratio of 1.62 (95% CI 1.35, 1.93; P < 0.001). Patients were diagnosed with osteoporosis at a considerably younger age than controls [60.1 (s.d. 12.4) vs 62.5 (s.d. 11.0) years; P = 0.028]. A total of 56 FMF patients were diagnosed with femoral neck fracture compared with 35 controls, resulting in an incidence rate of 5.3 and 3.3, respectively, and a crude HR of 1.60 (95% CI 1.05, 2.44; P < 0.05). CONCLUSION FMF patients are at increased risk for osteoporosis and consequently femur fracture. Our findings emphasize the importance of considering bone health in the management of FMF patients.
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Affiliation(s)
- Yonatan Shneor Patt
- Department of Internal Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Niv Ben-Shabat
- Department of Internal Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Lior Fisher
- Department of Internal Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Kassem Sharif
- Department of Internal Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Gastroenterology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Mohamad Arow
- Department of Internal Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Simon Lassman
- Department of Internal Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- St George's Hospital, University of London, London, UK
| | - Abdulla Watad
- Department of Internal Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Vita Skuja
- Department of Internal Medicine, Riga Stradins University, Riga, Latvia
- Anti-Aging Institute, Health Center 4, Riga, Latvia
| | - Anan H Shtewe
- Department of Orthopedic Surgery, Spine Surgery Service, Sheba Medical Center, Tel-Hashomer, Israel
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton, Leeds Teaching Hospital Trust, Leeds, UK
| | - Howard Amital
- Department of Internal Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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TOKER H, YUCE HBALCI, YILDIRIM A, TEKİN MB, GEVREK F. The effect of colchicine on alveolar bone loss in ligature-induced periodontitis. Braz Oral Res 2019; 33:e001. [DOI: 10.1590/1807-3107bor-2019.vol33.0001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 11/12/2018] [Indexed: 12/16/2022] Open
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Bindoli S, Franceschet G, Galozzi P, Zaninotto M, Camozzi V, Sfriso P. Osteoporosis in Systemic Autoinflammatory Diseases: A Case-Control Study. Front Endocrinol (Lausanne) 2019; 10:636. [PMID: 31620089 PMCID: PMC6759948 DOI: 10.3389/fendo.2019.00636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 09/03/2019] [Indexed: 01/22/2023] Open
Abstract
Objective: To assess if patients affected by systemic autoinflammatory diseases (SAIDs) present an increased risk of osteoporosis (OP). Methods: Forty adults patients referred to the Rheumatology Unit of Padova University Hospital affected by Familial Mediterranean Fever (FMF), TNF-Receptor Associated Periodic Syndrome (TRAPS), and Mevalonate Kinase Deficiency (MKD) and 40 healthy subjects were enrolled. Blood and urine samples were collected in order to define phosphocalcic metabolism, including Receptor activator of nuclear factor kappa-B ligand (RANKL) and osteoprotegerin (OPG), and among inflammatory markers serum amyloid A (SAA). Femur and lumbar dual-energy X-ray absorptiometry (DXA) scans were performed and Trabecular Bone Score (TBS) was calculated on DXA lumbar images. Results: We did not observe a statistically significant difference between Bone Mineral Density (BMD) and TBS of patients compared to controls. Also, the values of phosphocalcic metabolites in patients did not statistically differ from those in controls. However, SAA and OPG levels were significantly higher in patients compared to healthy subjects (p = 0.0244 and p = 0.0064, respectively). Conclusion: Patients of our cohort affected by FMF, TRAPS, and MKD do not present an increased risk of OP compared to the healthy controls. TBS and BMD are similar between the two groups underlining a preserved bone quality in patients. High OPG levels could suggest a protective role and a bone re-balancing action in response to an inflammatory background. Finally, it should be taken into account a modulatory role played by a pro-inflammatory cytokine such as SAA on bone homeostasis.
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Affiliation(s)
- Sara Bindoli
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Giulio Franceschet
- Endocrinology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Paola Galozzi
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Martina Zaninotto
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy
| | - Valentina Camozzi
- Endocrinology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Paolo Sfriso
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
- *Correspondence: Paolo Sfriso
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ter Haar NM, Annink KV, Al-Mayouf SM, Amaryan G, Anton J, Barron KS, Benseler SM, Brogan PA, Cantarini L, Cattalini M, Cochino AV, De Benedetti F, Dedeoglu F, De Jesus AA, Della Casa Alberighi O, Demirkaya E, Dolezalova P, Durrant KL, Fabio G, Gallizzi R, Goldbach-Mansky R, Hachulla E, Hentgen V, Herlin T, Hofer M, Hoffman HM, Insalaco A, Jansson AF, Kallinich T, Koné-Paut I, Kozlova A, Kuemmerle-Deschner JB, Lachmann HJ, Laxer RM, Martini A, Nielsen S, Nikishina I, Ombrello AK, Ozen S, Papadopoulou-Alataki E, Quartier P, Rigante D, Russo R, Simon A, Trachana M, Uziel Y, Ravelli A, Gattorno M, Frenkel J. Development of the autoinflammatory disease damage index (ADDI). Ann Rheum Dis 2016; 76:821-830. [PMID: 27811147 DOI: 10.1136/annrheumdis-2016-210092] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/27/2016] [Accepted: 10/08/2016] [Indexed: 11/04/2022]
Abstract
ObjectivesAutoinflammatory diseases cause systemic inflammation that can result in damage to multiple organs. A validated instrument is essential to quantify damage in individual patients and to compare disease outcomes in clinical studies. Currently, there is no such tool. Our objective was to develop a common autoinflammatory disease damage index (ADDI) for familial Mediterranean fever, cryopyrin-associated periodic syndromes, tumour necrosis factor receptor-associated periodic fever syndrome and mevalonate kinase deficiency.MethodsWe developed the ADDI by consensus building. The top 40 enrollers of patients in the Eurofever Registry and 9 experts from the Americas participated in multiple rounds of online surveys to select items and definitions. Further, 22 (parents of) patients rated damage items and suggested new items. A consensus meeting was held to refine the items and definitions, which were then formally weighted in a scoring system derived using decision-making software, known as 1000minds.ResultsMore than 80% of the experts and patients completed the online surveys. The preliminary ADDI contains 18 items, categorised in the following eight organ systems: reproductive, renal/amyloidosis, developmental, serosal, neurological, ears, ocular and musculoskeletal damage. The categories renal/amyloidosis and neurological damage were assigned the highest number of points, serosal damage the lowest number of points. The involvement of (parents of) patients resulted in the inclusion of, for example, chronic musculoskeletal pain.ConclusionsAn instrument to measure damage caused by autoinflammatory diseases is developed based on consensus building. Patients fulfilled a significant role in this process.
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Salah S, El-Masry SA, Sheba HF, El-Banna RA, Saad W. Bone Mineral Density in Egyptian Children with Familial Mediterranean Fever. IRANIAN JOURNAL OF MEDICAL SCIENCES 2016; 41:2-8. [PMID: 26722138 PMCID: PMC4691266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND Familial Mediterranean fever (FMF) has episodic or subclinical inflammation that may lead to a decrease in bone mineral density (BMD). The objective of this study was to assess BMD in Egyptian children with FMF on genetic basis. METHODS A cross sectional study included 45 FMF patients and 25 control children of both sexes in the age range between 3-16 years old. The patients were reclassified into two groups, namely group I(A) with 23 cases using colchicine for 1 month or less, and group I(B) with 22 cases using colchicine for more than 6 months. For both the patients and control groups, MEFV mutations were defined using molecular genetics technique and BMD was measured by DXA at the proximal femur and lumbar spines. RESULTS Four frequent gene mutations were found in the patient group E148Q (35.6%), V726A (33.3%), M680I (28.9%), and M694V (2.2%). There were also four heterozygous gene mutations in 40% of the control children. Patients receiving colchicine treatment for less than 1 month had highly significant lower values of BMD at the femur and lumbar spines than the control children (P=0.007, P<0.001). Patients receiving colchicine treatment for more than 6 months had improved values of BMD at femur compared with the control, but there were still significant differences between them in lumbar spine (P=0.036). There were insignificant effect of gene mutation type on BMD and the risk of osteopenia among the patients. CONCLUSION FMF had a significant effect on BMD. However, regular use of colchicine treatment improves this effect mainly at the femur.
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Affiliation(s)
- Samia Salah
- Rheumatology Department, Abo El-Rish Children Hospital, Cairo University, Giza, Egypt
| | - Sahar A El-Masry
- Biological Anthropology Department, Medical Research Division, National Research Centre, Giza, Egypt,Correspondence: Sahar A El-Masry, PhD; National Research Centre, El-Bohooth Street (former El-Tahrir street), Dokki, P.O. Box: 12622, Cairo, Egypt
| | - Hala Fathy Sheba
- Clinical Pathology Department, Kasr El-Aini Hospital, Cairo University, Giza, Egypt
| | - Rokia A El-Banna
- Biological Anthropology Department, Medical Research Division, National Research Centre, Giza, Egypt
| | - Walaa Saad
- Biological Anthropology Department, Medical Research Division, National Research Centre, Giza, Egypt
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Aydın T, Taspınar O, Akbal Y, Peru C, Guler M, Uysal O, Yakıcıer MC. Serum bone markers levels and bone mineral density in familial mediterranean Fever. J Phys Ther Sci 2014; 26:1459-63. [PMID: 25276036 PMCID: PMC4175257 DOI: 10.1589/jpts.26.1459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 03/31/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this study was to measure bone mineral density, serum and urinary
bone turnover parameters, and to evaluate the influence of demographic and genetic factors
on these parameters in FMF patients. [Subjects and Methods] Twenty-seven attack-free
patients who were diagnosed with FMF (in accordance with Tel Hashomer criteria) were
recruited at outpatient rheumatology clinics. We investigated whether there were any
differences between the FMF patients and a control group in terms of lumbar and femur bone
mineral density (BMD), standard deviation scores (Z scores and T scores) and bone markers.
[Results] In terms of the median values of lumbar BMD (p = 0.21), lumbar T (p = 0.098) and
Z (p = 0.109) scores, femoral neck BMD, femoral T and Z scores and total femur BMD, T (p =
0.788) and Z scores, there were no significant differences. [Conclusion] In our study, no
statistically significant differences were found between FMF patients and a control group
in terms of osteoporosis. The 25-OH vitamin D was found to be significantly lower in FMF
patients than in the control group.
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Affiliation(s)
- Teoman Aydın
- Department of Physıcal Therapy and Rehabılıtatıon, Bezm-i Alem Vakıf Foundatıon Unıversıty School of Medıcıne, Türkiye
| | - Ozgur Taspınar
- Department of Physıcal Therapy and Rehabılıtatıon, Bezm-i Alem Vakıf Foundatıon Unıversıty School of Medıcıne, Türkiye
| | - Yildiz Akbal
- Department of Physıcal Therapy and Rehabılıtatıon, Bezm-i Alem Vakıf Foundatıon Unıversıty School of Medıcıne, Türkiye
| | - Celaleddin Peru
- Department of Internal Medıcıne, Bezm-i Alem Vakıf Foundatıon Unıversıty School of Medıcıne, Türkiye
| | - Mustafa Guler
- Department of Physıcal Therapy and Rehabılıtatıon, Bezm-i Alem Vakıf Foundatıon Unıversıty School of Medıcıne, Türkiye
| | - Omer Uysal
- Department of Bıoıstatistıcs, Bezm-i Alem Vakıf Foundatıon Unıversıty School of Medıcıne, Türkiye
| | - M Cengiz Yakıcıer
- Acıbadem Universıty School of Medıcıne, Department of Molecular Bıology and Genetıcs, Türkiye
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