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Clinical Rheumatology

Erschienen in:

01.04.2020 | Original Article

A meta-analysis of fracture risk and bone mineral density in patients with systemic sclerosis

verfasst von: Juan Chen, Ling Lei, Jie Pan, Cheng Zhao

Erschienen in: Clinical Rheumatology | Ausgabe 4/2020

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Abstract

Introduction

Osteoporosis and fractures are important public health issues that impose serious burdens on patients. Patients with systemic sclerosis (SSc) have low bone mineral density (BMD) and increased risk for fracture. We aimed to explore the association between SSc and BMD and fracture risk.

Methods

For this meta-analysis, we analyzed data from articles that reported mean differences in BMD or fracture risk between patients with SSc and controls. We undertook a systematic literature search of the PubMed, Web of Science, and Cochrane Library databases. The pooled weighted mean difference (WMD) was used to estimate the mean difference in BMD between patients with SSc and controls. Pooled odds ratios (ORs; with 95% confidence intervals [95% CIs]) were used to assess the association between SSc and fracture risk.

Results

Analysis of the results from 18 studies showed that patients with SSc had significantly lower BMD than controls in the following categories: whole body (WMD − 0.07, 95% CI − 0.1 to − 0.04, p < 0.00001), lumbar spine (WMD − 0.08, 95% CI − 0.11 to − 0.05, p < 0.00001), femoral neck (WMD: −0.28, 95% CI: −0.46 to −0.10, p=0.002), total hip (WMD − 0.10, 95% CI − 0.14 to − 0.06, p < 0.00001), and femoral trochanter (WMD − 0.06, 95% CI − 0.09 to − 0.03, p < 0.0001). Moreover, patients with SSc had an increased risk of vertebral fracture (OR 10.38, 95% CI 1.19 to 90.58, p = 0.03). We did not find a significant difference in the risk of osteoporotic fracture between patients with SSc and controls (OR = 2.24, 95% CI 0.58 to 8.59, p = 0.24).

Conclusion

Patients with SSc have a significant reduction in bone mass, and these patients have an increased risk of vertebral fracture. The early monitoring of BMD in patients with SSc is recommended for the prevention of osteoporosis and fracture.

Key points

• SSc patients have a significant low BMD

• SSc patients also have an increased risk of vertebral fracture

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Baron M, Lee P (1982) The articular manifestations of progressive systemic sclerosis (scleroderma). Ann Rheum Dis 41(2):147–152CrossRefPubMedPubMedCentral

Johnson SR, Glaman DD, Schentag CT (2006) Quality of life and functional status in systemic sclerosis compared to other rheumatic diseases. J Rheumatol 33(6):1117–1122PubMed

Saketkoo LA, Magnus JH, Doyle MK (2014) The primary care physician in the early diagnosis of systemic sclerosis:the cornerstone of recognition and hope. Am J Med Sci 347(1):54–63. https://doi.org/10.1097/MAJ.0b013e3182a55d24 CrossRefPubMed

Bijlsma AY, Meskers CG, Westendorp RG, Maier AB (2012) Chronology of age-related disease definitions: osteoporosis and sarcopenia. Ageing Res Rev 11(2):320–324. https://doi.org/10.1016/j.arr.2012.01.001 CrossRefPubMed

Rachner TD, Khosla S (2011) Osteoporosis: now and the future. Lancet 377(9773):1276–1287. https://doi.org/10.1016/S0140-6736(10)62349-5 CrossRefPubMedPubMedCentral

Omair MA, Pagnoux C, McDonald-Blumer H, Johnson SR (2013) Low bone density in systemic sclerosis a systematic review. Rheumatol 40(11):1881–1890. https://doi.org/10.3899/jrheum.130032 CrossRef

Stone KL, Seeley DG, Lui LY, Cauley JA, Ensrud K, Browner WS, Nevitt MC, Cummings SR, Osteoporotic Fractures Research Group (2003) BMD at multiple sites and risk of fracture of multiple types:long-term results from the Study of Osteoporotic Fractures. Bone Miner Res 18(11):1947–1954. https://doi.org/10.1359/jbmr.2003.18.11.1947 CrossRef

Trajanoska K, Schoufour JD, de Jonge EAL, Kieboom BCT, Mulder M, Stricker BH, Voortman T, Uitterlinden AG, Oei EHG (2018) Fracture incidence and secular trends between 1989 and 2013 in a population based cohort: the Rotterdam study. Bone 114:116–124. https://doi.org/10.1016/j.bone.2018.06.004 CrossRefPubMed

Lee JE, Kim KM, Kim LK, Kim KY, Oh TJ, Moon JH, Choi SH, Lim S, Kim SW, Shin CS, Jang HC (2017) Comparisons of TBS and lumbar spine BMD in theassociations with vertebral fractures according to the T-scores: a cross-sectional observation. Bone 105:269–275. https://doi.org/10.1016/j.bone.2017.09.017 CrossRefPubMed

10.

Weiss RJ, Wick MC, Ackermann PW, Montgomery SM (2010) Increased fracture risk in patients with rheumatic disorders and other inflammatory diseases--a case-control study with 53,108 patients with fracture. J Rheumatol 37(11):2247–2250. https://doi.org/10.3899/jrheum.100363 CrossRefPubMed

11.

Wang X, Yan S, Liu C, Xu Y, Wan L, Wang Y, Gao W, Meng S, Liu Y, Liu R, Xu D (2016) Fracture risk and bone mineral density levels in patients with syste mic lupus erythematosus: a systematic review and meta-analysis. Osteoporos Int 27(4):1413–1423. https://doi.org/10.1007/s00198-015-3449-7 CrossRefPubMed

12.

Lai CC, Wang SH, Chen WS, Liu CJ, Chen TJ, Lee PC, Chang YS (2015) Increased risk of osteoporotic fractures in patients with systemic sclerosis:a nationwide population-based study. Ann Rheum Dis 74(7):1347–1352. https://doi.org/10.1136/annrheumdis-2013-204832 CrossRefPubMed

13.

Wan YN, Zhang L, Wang YJ, Yan JW, Wang BX, Wang J (2014) The association between systemic sclerosis and bone mineral density-a meta-analysis of observational studies. Int J Rheum Dis 17(8):845–855. https://doi.org/10.1111/1756-185X.12395 CrossRefPubMed

14.

Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700CrossRefPubMedPubMedCentral

15.

Zeng X, Zhang Y, Kwong JS, Zhang C, Li S, Sun F, Niu Y, Du L (2015) The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta-analysis, and clinical practice guideline: a systematic review. Evid Based Med 8(1):2–10. https://doi.org/10.1111/jebm.12141 CrossRef

16.

Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560. https://doi.org/10.1136/bmj.327.7414.557 CrossRefPubMedPubMedCentral

17.

Ruaro B, Casabella A, Paolino S, Pizzorni C, Alessandri E, Seriolo C, Botticella G, Molfetta L, Odetti P, Smith V (2018) Correlation between bone quality and microvascular damage in systemic sclerosis patients. Rheumatology(Oxford) 57(9):1548–1554. https://doi.org/10.1093/rheumatology/key130 CrossRef

18.

Di Munno O, Mazzantini M, Massei P, Massei P, Ferdeghini M, Pitaro N, Latorraca A, Ferri C (1995) Reduced bone mass and normal calcium metabolism in systemic sclerosis with and without calcinosis. Clin Rheumatol 14(4):407–412CrossRefPubMed

19.

da Silva HC,Szejnfeld VL,Assis LS, Sato EI (1997) [Study of bone density in systemic scleroderma. Rev Assoc Med Bras(1992)43(1):40–46

20.

Carbone L, Tylavsky F, Wan J, McKown K, Cheng S (1999) Bone mineral density in scleroderma. Rheumatology(Oxford) 38(4):371–372CrossRef

21.

Frediani B, Baldi F, Falsetti P, Acciai C, Filippou G, Spreafico A, Chellini F, Capperucci C, Filipponi P, Galeazzi M (2004) Bone mineral density in patients with systemic sclerosis. Ann Rheum Dis 63(3):326–327CrossRefPubMedPubMedCentral

22.

Sampaio-Barros PD, Costa-Paiva L, Filardi S, Sachetto Z, Samara AM, Marques-Neto JF (2005) Prognostic factors of low bone mineral density in systemic sclerosis. Clin Exp Rheumatol 23(2):180–184PubMed

23.

Souza RB, Borges CT, Takayama L, Aldrighi JM, Pereira RM (2006) Systemic sclerosis and bone loss:the role of the disease and body composition. Scand J Rheumatol 35(5):384–387. https://doi.org/10.1080/03009740600704296 CrossRefPubMed

24.

Mok CC, Chan PT, Chan KL, Ma KM (2013) Prevalence and risk factors of low bone mineral density in Chinese patients with systemic sclerosis:a case-control study. Rheumatology(Oxford) 52(2):296–303. https://doi.org/10.1093/rheumatology/kes240 CrossRef

25.

Kilic G, Kilic E, Akgul O, Ozgocmen S (2016) Increased risk for bone loss in women with systemic sclerosis:a comparative study with rheumatoid arthritis. Int J Rheum Dis 19(4):405–411. https://doi.org/10.1111/1756-185X.12242 CrossRefPubMed

26.

Koumakis E, Avouac J, Winzenrieth R, Toth E, Payet J, Kahan A, Allanore Y, Cormier C (2015) Trabecular bone score in female patients with systemic sclerosis:comparison with rheumatoid arthritis and influence of glucocorticoid exposure. J Rheumatol 42(2):228–235. https://doi.org/10.3899/jrheum.140752 CrossRefPubMed

27.

Marot M, Valéry A, Esteve E, Bens G, Müller A, Rist S, Toumi H, Lespessailles E (2015) Prevalence and predictive factors of osteoporosis in systemic sclerosis patients: a case-control study. Oncotarget 6(17):14865–14873. https://doi.org/10.18632/oncotarget.3806 CrossRefPubMedPubMedCentral

28.

Alekperov RТ, Smirnov AV, Toroptsova NV, Kudinsky DM (2016) Bone mineral density in patients with scleroderma systematica. Ter Arkh 88(5):37–42CrossRef

29.

Ibn Yacoub Y, Amine B, Laatiris A, Wafki F, Znat F, Hajjaj-Hassouni N (2012) Bone density in Moroccan women with systemic scleroderma and its relationships with disease-related parameters and vitamin D status. Rheumatol Int 32(10):3143–3148. https://doi.org/10.1007/s00296-011-2150-1 CrossRefPubMed

30.

Atteritano M,Sorbara S,Bagnato G,Miceli G,Sangari D,Morgante S,Visalli E,Bagnato G(2013) Bone mineral density,bone turnover markers and fractures in patients with systemic sclerosis: a case control study. PLoS One 8(6):e66991.DOI:https://doi.org/10.1371/journal.pone.0066991,

31.

Cheng S, Tylavsky FA, Orwoll ES, Rho JY, Carbone LD (1999) The role of collagen abnormalities in ultrasound and densitometry assessment: in vivo evidence. Calcif Tissue Int 64(6):470–476CrossRefPubMed

32.

Avouac J, Koumakis E, Toth E, Meunier M, Maury E, Kahan A, Cormier C, Allanore Y (2012) Increased risk of osteoporosis and fracture in women with systemic sclerosis:a comparative study with rheumatoid arthritis. Arthritis Care Res(Hoboken) 64(12):1871–1878. https://doi.org/10.1002/acr.21761 CrossRef

33.

Marighela TF, Genaro Pde S, Pinheiro MM, Szejnfeld VL, Kayser C (2013) Risk factors for body composition abnormalities in systemic sclerosis. Clin Rheumatol 32(7):1037–1044. https://doi.org/10.1007/s10067-013-2235-1 CrossRefPubMed

34.

An L, Sun MH, Chen F, Li JR (2017) Vitamin D levels in systemic sclerosis patients:a meta-analysis. Drug Des Devel Ther 11:3119–3125. https://doi.org/10.2147/DDDT.S144860 CrossRefPubMedPubMedCentral

35.

Atlan L, Ibrahim-Nasser N, Valery A, Bazzi C, Rollin F, Bens G, Marot M, Estève E, Lespessailles E (2018) Bone mineral density and microarchitecture linkages with micro-and macro-vascular impairments at the hand in systemic sclerosis: an HRpQCT study. Oncotarget 9(50):29484–29494. https://doi.org/10.18632/oncotarget.25681 CrossRefPubMedPubMedCentral

36.

Robberecht E, Vandewalle S, Wehlou C, Kaufman JM, De Schepper J (2011) Sunlight is an important determinant of vitamin D serum concentrations in cystic fibrosis. Eur J Clin Nutr 65(5):574–579. https://doi.org/10.1038/ejcn.2010.280 CrossRefPubMed

37.

Arnson Y, Amital H, Agmon-Levin N, Alon D, Sánchez-Castañón M, López-Hoyos M, Matucci-Cerinic M, Szücs G, Shapira Y (2011) Serum 25-OH vitamin D concentrations are linked with various clinical aspects in patients with systemic sclerosis: a retrospective cohort study and review of the literature. Autoimmun Rev 10(8):490–494. https://doi.org/10.1016/j.autrev.2011.02.002 CrossRefPubMed

38.

Macdonald HM, Reid IR, Gamble GD, Fraser WD, Tang JC, Wood AD (2018) 25-hydroxyvitamin D threshold for the effects of vitamin d supplements on bone density: secondary analysis of a randomized controlled trial. J Bone Miner Res 33(8):1464–1469. https://doi.org/10.1002/jbmr.3442 CrossRefPubMed

39.

Liang DK, Bai XJ, Wu B, Han LL, Wang XN, Yang J, Chen XM (2014) Associations between bone mineral density and subclinical atherosclerosis:a cross-sectional study of a Chinese population. J Clin Endocrinol Metab 99(2):469–477. https://doi.org/10.1210/jc.2013-2572 CrossRefPubMed

40.

Wagenknecht LE, Divers J, Register TC, Russell GB, Bowden DW, Xu J, Langefeld CD, Lenchik L, Hruska KA, Carr JJ (2016) Bone mineral density and progression of subclinical atherosclerosis in African-Americans with type 2 diabetes. J Clin Endocrinol Metab 101(11):4135–4141. https://doi.org/10.1210/jc.2016-1934 CrossRefPubMedPubMedCentral

41.

Cappelli L, Wigley FM (2015) Management of Raynaud phenomenon and digital ulcers in scleroderma. Rheum Dis Clin N Am 41(3):419–438. https://doi.org/10.1016/j.rdc.2015.04.005 CrossRef

42.

Morardet L, Avouac J, Sammour M, Baron M, Kahan A, Feydy A, Allanore Y (2016) Late nailfold videocapillaroscopy pattern associated with hand calcinosis and acro-osteolysis in systemic sclerosis. Arthritis Care Res(Hoboken) 68(3):366–373. https://doi.org/10.1002/acr.22672 CrossRef

43.

Valenzuela A, Baron M et al (2016) Calcinosis is associated with digital ulcers and osteoporosis in patients with systemic sclerosis: a scleroderma clinical trials consortium study. Semin Arthritis Rheum 46(3):344–349. https://doi.org/10.1016/j.semarthrit.2016.05.008 CrossRefPubMedPubMedCentral

44.

Lampropoulos CE, Papaioannou I, D’Cruz DP (2012) Osteoporosis--a risk factor for cardiovascular disease? Nat Rev Rheumatol 8(10):587–598. https://doi.org/10.1038/nrrheum.2012.120 CrossRefPubMed

45.

Wu M, Rementer C, Giachelli CM (2013) Vascular calcification: an update on mechanisms and challenges in treatment. Calcif Tissue Int 93(4):365–373. https://doi.org/10.1007/s00223-013-9712-z CrossRefPubMedPubMedCentral

46.

Dovio A, Data V, Carignola R, Calzolari G, Vitetta R, Ventura M, Saba L, Severino A, Angeli A (2008) Circulating osteoprotegerin and soluble RANK ligand in systemic sclerosis. J Rheumatol 35(11):2206–2213CrossRefPubMed

47.

Stegen S, Carmeliet G (2018) The skeletal vascular system-breathing life into bone tissue. Bone 115:50–58. https://doi.org/10.1016/j.bone.2017.08.022 CrossRefPubMed

Titel: A meta-analysis of fracture risk and bone mineral density in patients with systemic sclerosis
verfasst von: Juan Chen
Ling Lei
Jie Pan
Cheng Zhao
Publikationsdatum: 01.04.2020
Verlag: Springer London
Erschienen in: Clinical Rheumatology / Ausgabe 4/2020
Print ISSN: 0770-3198
Elektronische ISSN: 1434-9949
DOI: https://doi.org/10.1007/s10067-019-04847-0

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A meta-analysis of fracture risk and bone mineral density in patients with systemic sclerosis

Abstract

Introduction

Methods

Results

Conclusion

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Abstract

Introduction

Methods

Results

Conclusion

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