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Prevalence and Risk Factors of Reduced Bone Mineral Density in Systemic Lupus Erythematosus Patients: A Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:3731648. [PMID: 30915352 PMCID: PMC6402203 DOI: 10.1155/2019/3731648] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/22/2019] [Indexed: 01/09/2023]
Abstract
Background We aimed to conduct a meta-analysis concerning the frequency and risk factors of reduced bone mineral density (BMD) in systemic lupus erythematosus (SLE) with evidence from published studies. Methods A comprehensive literature search was conducted based on the EMBASE, Web of Science, PubMed, and Cochrane Library databases up to March 5th, 2017. Eligible studies reported any prevalence of reduced BMD in SLE patients. All risk factors with odds ratios or risk ratios associated with reduced BMD were extracted. Results 71 reports with 33527 SLE patients were included. Low BMD, osteopenia, and osteoporosis at any site were presented, respectively, in 45%, 38%, and 13% of the SLE patients. The prevalence of osteoporosis increased with the advancing of age, while U-shaped associations between age and the prevalence of low BMD and osteopenia were found. Lumbar spine was indicated to have higher prevalence of osteoporosis. Age, disease duration, drugs use, and many other factors were identified as predictors of reduced BMD. Conclusion Low BMD, osteoporosis, and osteopenia appeared to be prevalent in patients with SLE. Risk factors of reduced BMD were various.
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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: 4.2] [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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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: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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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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Wang X, Yan S, Liu C, Xu Y, Wan L, Wang Y, Gao W, Meng S, Liu Y, Liu R, Xu D. Fracture risk and bone mineral density levels in patients with systemic lupus erythematosus: a systematic review and meta-analysis. Osteoporos Int 2016; 27:1413-1423. [PMID: 26753541 DOI: 10.1007/s00198-015-3449-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 12/01/2015] [Indexed: 12/16/2022]
Abstract
Previous studies suggested possible bone loss and fracture risk in patients with systemic lupus erythematosus (SLE). The aim of this systematic review and meta-analysis was to assess the strength of the relationship of SLE with fracture risk and the mean difference of bone mineral density (BMD) levels between SLE patients and controls. Literature search was undertaken in multiple indexing databases on September 26, 2015. Studies on the relationship of SLE with fracture risk and the mean difference of BMD levels between SLE patients and controls were included. Data were combined using standard methods of meta-analysis. Twenty-one studies were finally included into the meta-analysis, including 15 studies on the mean difference of BMD levels between SLE patients and controls, and 6 studies were on fracture risk associated with SLE. The meta-analysis showed that SLE patients had significantly lower BMD levels than controls in the whole body (weighted mean difference [WMD] = -0.04; 95 % CI -0.06 to -0.02; P < 0.001), femoral neck (WMD = -0.06; 95 % CI -0.07 to -0.04; P < 0.001), lumbar spine (WMD = -0.06; 95 % CI -0.09 to -0.03; P < 0.001), and total hip (WMD = -0.05; 95 % CI -0.06 to -0.03; P < 0.001). In addition, the meta-analysis also showed that SLE was significantly associated with increased fracture risk of all sites (relative risk [RR] = 1.97, 95 % CI 1.20-3.25; P = 0.008). Subgroup analysis by adjustment showed that SLE was significantly associated with increased fracture risk of all sites before and after adjusting for confounding factors (unadjusted RR = 2.07, 95 % CI 1.46-2.94, P < 0.001; adjusted RR = 1.22, 95 % CI 1.05-1.42, P = 0.01). Subgroup analysis by types of fracture showed that SLE was significantly associated with increased risks of hip fracture (RR = 1.99, 95 % CI 1.55-2.57; P < 0.001), osteoporotic fracture (RR = 1.36, 95 % CI 1.21-1.53; P < 0.001), and vertebral fracture (RR = 2.97, 95 % CI 1.71-5.16; P < 0.001). This systematic review and meta-analysis provides strong evidence for the relationship of SLE with bone loss and fracture risk.
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Affiliation(s)
- X Wang
- Department of Rheumatology and Immunology, The Affiliated Hospital of Weifang Medical University, Weifang, 261000, Shandong Province, China
| | - S Yan
- Department of Anorectal Surgery, The Affiliated Hospital of Weifang Medical University, Weifang, 261000, China
| | - C Liu
- Clinical Laboratory, First Affiliated Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - Y Xu
- Occupational Safety and Health Research Center of the State Administration of Work Safety, Beijing, 100000, China
| | - L Wan
- Department of Rheumatology and Immunology, The Affiliated Hospital of Weifang Medical University, Weifang, 261000, Shandong Province, China
| | - Y Wang
- Department of Rheumatology and Immunology, The Affiliated Hospital of Weifang Medical University, Weifang, 261000, Shandong Province, China
| | - W Gao
- Department of Rheumatology and Immunology, The Affiliated Hospital of Weifang Medical University, Weifang, 261000, Shandong Province, China
| | - S Meng
- Department of Rheumatology and Immunology, The Affiliated Hospital of Weifang Medical University, Weifang, 261000, Shandong Province, China
| | - Y Liu
- Department of Rheumatology and Immunology, The Affiliated Hospital of Weifang Medical University, Weifang, 261000, Shandong Province, China
| | - R Liu
- Department of Rheumatology and Immunology, The Affiliated Hospital of Weifang Medical University, Weifang, 261000, Shandong Province, China.
| | - D Xu
- Department of Rheumatology and Immunology, The Affiliated Hospital of Weifang Medical University, Weifang, 261000, Shandong Province, China.
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Rentero ML, Amigo E, Chozas N, Fernández Prada M, Silva-Fernández L, Abad Hernandez MA, Rodriguez Barrera JM, del Pino-Montes J. Prevalence of fractures in women with rheumatoid arthritis and/or systemic lupus erythematosus on chronic glucocorticoid therapy. BMC Musculoskelet Disord 2015; 16:300. [PMID: 26472426 PMCID: PMC4608160 DOI: 10.1186/s12891-015-0733-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 09/24/2015] [Indexed: 11/24/2022] Open
Abstract
Background Glucocorticoid (GC) therapy is associated with an increased risk of fractures. The main objective of this study was to determine the prevalence of undiagnosed vertebral fractures in women chronically using GC therapy for autoimmune disorders. We also determined the prevalence of non-vertebral fractures, and investigated whether factors such as quality-of-life and future fracture risk are associated with vertebral/non-vertebral fractures. Methods This was a multicenter cross-sectional study conducted in Spain. All women had rheumatoid arthritis (RA) and/or systemic lupus erythematosus (SLE). Radiological morphometric vertebral fractures were evaluated centrally (Genant semiquantitative method), whereas non-vertebral fractures were not assessed by radiography. Before radiography, patients were asked whether they had vertebral/non-vertebral fractures, hereafter referred to as ‘self-reported’ fractures. Assessment tools included the Disease Activity Score (DAS28), the SF-36 questionnaire, and FRAX®. Results Complete data were obtained for 576 outpatients with RA and/or SLE (83.3 % had RA); mean [SD] age 59.6 [15] years. Of all patients, 6.4 % had self-reported vertebral fractures, whereas 18.9 % had morphometric vertebral fractures (RA: 7.1 % self-reported vs. 20.0 % morphometric; SLE: 3.2 % self-reported vs. 13.7 % morphometric). Non-vertebral fractures were self-reported by 9.8 % of RA and 5.3 % of SLE patients. Low physical functioning was associated with morphometric vertebral fractures (mean [SD] SF-36 score 18.8 [6.0] when present vs. 20.1 [5.9] when absent; p = 0.028) and self-reported non-vertebral fractures (16.7 [5.2] when present vs. 20.1 [5.9] when absent; p < 0.001). Mean [SD] DAS28 was higher (p = 0.013) when any self-reported fractures were present (4.0 [1.3]) than absent (3.6 [1.3]). Based on FRAX® analysis, patients with vs. without morphometric vertebral fractures had higher 10-year probabilities of major osteoporotic fractures (mean [SD] 17.9 [12.9]% vs. 9.9 [9.6]%; p < 0.001) and hip fractures (11.0 [11.7]% vs. 4.6 [8.1]%; p < 0.001). Conclusions Morphometric vertebral fractures were detected in 18.9 % of patients, i.e. 3-times more frequently than verbally reported by patients. Patients with vs. without fractures had worse quality-of-life and increased fracture risk. Accordingly, it is of utmost importance that women chronically using GCs are assessed for fractures, including morphometric vertebral fractures.
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Affiliation(s)
| | - Encarna Amigo
- Hospital de Lugo, San Cibrao, s/n, 27003, Lugo, Spain.
| | - Nicolas Chozas
- Hospital Puerta del Mar, Av Ana de Viya, 21, 11009, Cádiz, Spain.
| | | | - Lucia Silva-Fernández
- Hospital Universitario Puerta de Hierro Majadahonda, Calle Manuel de Falla, 1, 28222, Majadahonda, Madrid, Spain.
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Health behaviors of Korean female nursing students in relation to obesity and osteoporosis. Nurs Outlook 2015; 63:504-11. [DOI: 10.1016/j.outlook.2015.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 01/27/2015] [Accepted: 02/08/2015] [Indexed: 11/23/2022]
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Jacobs J, Sjoe MWPTA, Voskuyl AE, Lems WF, Bultink IEM. Unexpected severe incident vertebral fractures in patients with systemic lupus erythematosus: comment on the article by Zhu et al. Lupus 2014; 24:222-3. [PMID: 25335489 DOI: 10.1177/0961203314556294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- J Jacobs
- Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
| | - M W P Tsang A Sjoe
- Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
| | - A E Voskuyl
- Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
| | - W F Lems
- Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
| | - I E M Bultink
- Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
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