Bone health

Attention required on bone health in people with lupus

Clinical Professor Charles Inderjeeth

Patients who have been hospitalised with lupus have more than double the risk of fractures as hospital-based controls without lupus.

Data from the Western Australia Rheumatic Disease Epidemiological Registry (WARDER), presented at the first joint ANZBMS-MEPSA-ANZORS meeting, highlights the multisystem nature of lupus and the need for improved primary prevention of osteoporosis in these patients.

The study compared non-trauma fracture risk and mortality in 2,440 adult patients with lupus and 10,220 controls over the study period 1980 – 2014.

Rheumatologist Clinical Professor Charles Inderjeeth, from North Metropolitan Health in WA and the University of Western Australia, told the meeting that a lupus diagnosis more than doubled the overall fracture risk (aHR 2.44).

In particular, patients had higher risk of vertebral fractures (aHR 5.73) but also hip fractures (aHR 1.83), lower limb, ankle and foot fractures (aHR 2.14) and hand, wrist and forearm fractures (aHR 1.95).

“Interestingly, those under the age of 70 years had a higher risk than those over the age of 70 years,” he said.

And the higher risk was persistent with lupus patients also having higher risk of five- (aHR 2.89) and 10-year (aHR 3.00) fracture recurrence.

“So if they have a fracture, the risk of further fracture was significantly elevated,” he said. “It was higher once again in <70s and sustained throughout the study period.”

There was also a higher risk of five-year mortality (aHR 1.56) with the risk highest in females (aHR 1.45), ≥70 years-old (aHR 1.72). The risk remained increased even in later years of the study, post-2000 (aHR 1.57).

“This data highlights the need for proactive primary and secondary fracture prevention in SLE,” he said.

Dr Inderjeeth said lupus itself, treatments such as glucocorticoids, and comorbidities all contributed to the higher fracture risk.

“For example, renal disease is a major driver for the impact on parathyroid hormone, calcitriol, calcium homeostasis and vitamin D,” he told the limbic.

He said rheumatologists were necessarily focused on managing lupus and its multiple end-organ complications which possibly distracted them from the importance of identifying “silent” bone disease.

He added that optimisation of medical management was critical along with screening patients for their risk of bone disease.

“We would normally expect that because they have a chronic inflammatory disease, that they probably should be screened for the risk of osteoporosis, offered advice on how to prevent their risk progressing, and reducing their risk of fracture consequent to that.”

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