Osteoporotic Fracture Risk Higher in Patients with Scleroderma

The risk of osteoporotic fractures (OFs) was raised among patients with systemic sclerosis (SSc), and particularly among women, according to a new study.

Researchers at Taipei Medical University (New Taipei City, Taiwan) conducted a cohort study using the Taiwan National Health Insurance database to identify the incidence rate and risk factors of OFs among 1,712 SSc patients (77.8% female, mean age 50.3 years),with respective age- and gender-matched controls. The primary endpoint of the study was the first occurrence of OF. The results showed that during a median follow-up of 5.2 years, 54 patients developed vertebral fractures, 17 patients developed hip fractures, and 7 patients developed radius fractures.

Compared with the controls, the incidence rate ratios (IRRs) among SSc patients were 1.78 for vertebral fractures and 1.89 for hip fractures. IRRs for overall OFs were 1.74 for women and 1.06 for men. SSc patients experienced hip fractures at a younger age, and had a higher one-year mortality rate from vertebral fractures than did the controls. The results indicated that older age, being female, using daily corticosteroids, and bowel dysmotility were associated with OF. The study was published in the July 2015 issue of the Annals of the Rheumatic Diseases.

“Physicians caring for SSc patients should focus on the increased risk of osteoporotic fractures, especially with risk factors. These patients should be evaluated for osteoporosis risk and any needed preventive strategies undertaken,” concluded lead author Yu-Sheng Chang, MD, and colleagues. “We also suggest that physicians make efforts to improve bowel motility and nutritional status of SSc patients, limit the use of steroids, and attempt to reduce the fall risk in these patients.”

SSc, also known as scleroderma, is a systemic connective tissue disease characterized by essential vasomotor disturbances and fibrosis and subsequent atrophy of skin, subcutaneous tissue, muscles, and internal organs. Immmunologic disturbances accompany these findings, and patients with SSc are likely to have low bone mineral density and osteoporosis. Contributory factors include the presence of chronic inflammation, use of corticosteroids, immobility, and gastrointestinal difficulties such as bowel dysmotility and malabsorption.

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