 |
|
|
 |
Self-Reported Fractures and Associated Factors in Women with Systemic Lupus Erythematosus CHIN LEE, ORIT ALMAGOR, DOROTHY D. DUNLOP, SUSAN MANZI, STEWART SPIES, and ROSALIND RAMSEY-GOLDMAN
ABSTRACT. Methods. Women with SLE (n = 304) completed this cross-sectional study conducted from 1996 to 2002. Self-reported fractures occurring after the diagnosis of SLE were evaluated. Hip and/or lumbar spine bone mineral density (BMD) was measured using dual-energy x-ray absorptiometry, and the results were expressed as BMD Z-scores. Multiple logistic regression analyses were performed to identify factors associated with fractures. Results. Of the 304 women with SLE, 12.5% experienced fractures. Those with fractures had significantly lower BMD Z-scores at the hip (Fracture group –0.55 vs No Fracture group –0.14, group difference 0.41; 95% CI 0.04 to 0.78), but not at the lumbar spine (Fracture group –0.25 vs No Fracture group –0.18, group difference 0.07; 95% CI –0.43 to 0.57). Among women with fractures, 60.5% and 63.2% had normal BMD Z-scores (BMD Z-score > –1.0) at the hip and lumbar spine, respectively, and 50.0% had normal BMD Z-scores at both anatomical sites. In multiple logistic regression analysis, each year of disease duration (adjusted OR 1.11; 95% CI 1.05 to 1.17) and use of osteoporosis medications (adjusted OR 4.75; 95% CI 1.62 to 13.94) were significantly associated with fractures. Conclusion. Longer duration of SLE and use of osteoporosis medications were significantly associated with fractures. Although women with fractures had significantly lower BMD Z-scores at the hip, an unexpectedly high proportion of women with SLE having normal BMD Z-score experienced fractures following SLE diagnosis. (First Release Sept 1 2007; J Rheumatol 2007;34:2018–23) Key Indexing Terms:
SYSTEMIC LUPUS ERYTHEMATOSUS
From the Department of Medicine, Division of Rheumatology; the Department of Physical Medicine and Rehabilitation; and the Institute for Healthcare Studies, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; the Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine and Graduate School of Public Health, Pittsburgh, Pennsylvania; and the Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA. Supported by grants from the National Institutes of Health K12-RR017707 (CL); K24-AR02213, RO1-AR4676402, RO1-HL074335, RO1-AR46588, NCRR/GCRC MO1-RR00056, AR02213; The Lupus Foundation of Pennsylvania (SM); K24-AR02318, P60-AR30692, P60-AR48098, NCRR/GCRC M01-RR00048), Arthritis Foundation Clinical Science Grant, The Lupus Foundation of Illinois, The Arthritis Foundation Greater Chicago Chapter, and unrestricted educational and research grants from Procter & Gamble Pharmaceuticals, Inc. and Merck Co., Inc. (RRG). C. Lee, MD, MPH, Department of Medicine, Division of Rheumatology; O. Almagor, MA; D.D. Dunlop, PhD, Institute for Healthcare Studies, Northwestern University, Feinberg School of Medicine; S. Manzi, MD, MPH, Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine and Graduate School of Public Health; S. Spies, MD, Department of Radiology; R. Ramsey-Goldman, MD, DrPH, Department of Medicine, Division of Rheumatology, Northwestern University, Feinberg School of Medicine. Address reprint requests to Dr. C. Lee, Northwestern University, Feinberg School of Medicine, Division of Rheumatology, 240 E. Huron, McGaw Pavilion, Suite M300, Chicago, IL 60611. E-mail: c-lee17@northwestern.edu Accepted for publication June 20, 2007. |
