AB0594 Prevalence of fragility fractures in women with sle, their connexionwith the course of the disease and the nature of pharmacotherapy

• Published in: Annals of the rheumatic diseases Vol. 77; no. Suppl 2; p. 1449
• Main Authors: Shevchuk, S., Denyschych, L., Shevchuk, E.
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.06.2018
• Subjects: Bone mass; Bone mineral density; Bone strength; Dual energy X-ray absorptiometry; Femur; Fractures; Glucocorticoids; Hip; Inflammation; Interleukin 6; Lupus; Osteopenia; Osteoporosis; Population studies; Post-menopause; Rheumatic diseases; Rheumatology; Spine (lumbar); Systemic lupus erythematosus; Vertebrae; Womens health
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/annrheumdis-2018-eular.3355

BackgroundPatients with rheumatic diseases are known to have the risk of osteoporosis and fragility fractures, which is significantly higher than in the healthy population. Recent studies demonstrate that age, sex, postmenopausal status, inactivity, glucocorticoid use, nutrition etc. play an important role in the reduction of bone mineral density (BMD) in systemic lupus erythematosus (SLE) patients. The role of the disease severity and the activity of the inflammatory process in the reduction BMD and the incidence of fractures in SLE patients is discursive.ObjectivesThe aim of the study was to determine the frequency of osteoporosis and fragility fractures in the Ukrainian SLE patients and to establish their connexion with the course of the disease.MethodsThe main study group involved 91 women with a diagnosis of SLE according to the American College of Rheumatology criteria. The disease activity was determined using the SLE Disease Activity Index (SLEDAI), and organ damage was measured using the Systemic Lupus International Collaborating Clinics American College of Rheumatology (SLICC/ACR) Damage Index. In all patients the cumulative dose of glucocorticoids was calculated. Serum CRP and IL-6 levels were determined by immunoassay. BMD at the lumbar spine (L1–L4) and femoral neck were measured using dual-energy X-ray absorptiometry. For pre-menopausal SLE patients BMD by Z-score <-2,0 SD was defined as «below expected range for age». For post-menopausal women osteoporosis was defined by T-score≤−2,5 SD, and osteopenia – between −1,0 and −2,5 SD. To determine fractures female SLE patients were examined with x-ray.ResultsIn pre-menopausal SLE patients the abnormal BMD of the lumbar spine was found in 9,8%, at the level of the femoral neck it was in 11,1%, in postmenopausal SLE patients – 18,4 and 13,6%, respectively. In the control group there was any premenopausal woman with low bone mass at both sites, whereas among postmenopausal individuals, these were 12,5 and 6,2%, respectively.Osteoporotic fractures were detected in 13 (14,2%) SLE patients, of which 30,7% had hip fractures and 69,3% had vertebral fractures. The reduction of bone strength and fractures were associated with a high damage index. In particular, in persons with fractures it equaled to 4,85±0,65 points, and in persons without fractures – 3,09±0,22 points. A similar tendency was detected by the disease activity SLEDAI. Glucocorticoid use also had a negative effect on the bone strength in patients with SLE. Thus, in women with fractures, the cumulative dose of glucocorticoids defined 60,9±6,63 g, and was by 37,1% higher than in patients without fractures.ConclusionsIn patients with SLE the prevalence of low BMD and fragility fractures is high. Progressive loss of the BMD and the occurrence of osteoporotic fractures are closely associated with the severity of organ damage and glucocorticoid use.Disclosure of InterestNone declared