Public health

Osteoporosis in Australian patients with systemic sclerosis: a need for screening?

Australian researchers have found a high prevalence of osteoporosis, osteopenia, and fractures among systemic sclerosis (SSc) patients.

The findings suggest bone density screening may be useful in at least some subgroups of SSc patients, according to rheumatologist at MonashHealth, Melbourne.

DXA scanning, performed in 104 participants from the Australian Scleroderma Cohort Study, revealed that 33.0% of the participants had osteoporosis and 52.7% had osteopenia. Only 14.3% of patients had normal bone density.

Twenty-three patients (10.2%) had had at least one fracture.

Most of the patients from a larger group of 244 patients had limited SSc (76.5%) while 23.6% had diffuse SSc. More than half had previously used prednisolone (59.7%).

The retrospective study found patients who had a DXA scan were significantly more likely to be female (91.3% vs 82.1% P = 0.040), older (mean age 65.9 vs 59.5 years, P = 0.001), and have longer disease duration (19.9 vs 15.2 years, P = 0.002), calcinosis (50.5% vs 36.4%, P = 0.028), synovitis (42.7% vs 28.6%, P = 0.022), or myositis (12.6% vs 0.7%, P < 0.001) than those who had not had a DXA scan.

“Patients who had undergone a DXA scan were also more likely to have had fractures (23.0% vs 0.0%, P < 0.001) or ever used vitamin D supplementation (71.8% vs 49.3%, P < 0.001), osteoporosis therapy (31.7% vs 4.4%, P < 0.001), or prednisolone (76.7% vs 47.1%, P < 0.001) compared with patients without DXA scanning.”

The study, published in the International Journal of Rheumatic Diseases, said patients with osteoporosis were significantly more likely to be Caucasian (93.3% vs 85.2%, P = 0.013), or have ever had IV TPN, regular NG feeding or PEG feeding (6.9% vs 0.0%, P = 0.038) than those with osteopenia or normal bone density.

However, patients with osteopenia or normal bone density were significantly more likely to have ever used prednisolone (85.2% vs 58.6%, P = 0.005) than those with osteoporosis.

The researchers said the negative correlation between prednisolone use and osteoporosis was surprising.

“The significantly younger age of patients who have ever used prednisolone may have contributed to its associated apparent reduction in rates of osteoporosis,” they said.

As well, prednisolone was not the mainstay of treatment in SSc and was generally avoided because of concerns about increased risk of scleroderma renal crisis.

“Fractures were significantly more common in patients with osteoporosis and osteopenia compared with those with normal bone density (29.3% vs 0.0%, P = 0.024).”

The findings suggest the need for a more considered approach to screening and, perhaps, a greater emphasis on osteoporosis management and prevention among SSc patients in Australia.

“These findings were consistent with rates of osteoporosis (30.0%-41.8%) and fractures (4.5%-35.0%) in international studies of SSc patients and exceeded the estimated prevalence of osteoporosis among Australians aged over 75 (20.0%).”

“Furthermore, our findings justify the use of prospective studies to use expensive, resource-intensive DXA scanning to further explore associations between SSc and osteoporosis in the future.”

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