Clinical study on osteoporosis and osteoporotic fracture in patients with rheumatic diseases / 中华风湿病学杂志

ABSTRACT

Objective To investigate the clinical features and related risk factors of osteoporosis and osteoporotic fracture (OPF) in patients with rheumatic diseases (RD),and the fracture predictive values of fracture risk assessment tool fracture risk assessment (FRAX(R))for Han patients.Methods A total of 313 untreated RD patients were included.Each individual BMD was measured at lumbar spine and femoral neck with Dual-energy X-ray absorptionary.Ten-year probability of fracture (％) was calculated by fracture risk assessment tool FRAX(R) of Chinese model.Each individual previous fracture was confirmed by X-ray or CT examination.The associations between BMD,FRAX),previous fracture and age,bone mass index,nationality,erythrocyte sedimentation rate (ESR) and RD types were analyzed.T test or Wilcoxon test was used to compare the difference between groups for statistical analysis.Pearson/Spearman rank order and binary regression were used to analyze the correlations between variables of normal/non-normal and two classification distribution.Results ① The BMD of patients with untreated RD was significantly lower than that of control group (P=0.000).Individuals diagnosed with "osteopenia" in the RD group and control group were accounted for 39.3％ (123/313) and 15.8％ (47/296) respectively.Individuals diagnosed with "osteoporosis" in RD group and control group were accounted for 11.5％ (36/313) and 5.4％ (16/296) respectively.② The next 10-year probability of the hip (Z=-2.28,P=0.02) and major osteoporotic fracture (Z=-1.98,P=0.03) were higher than those of the control group,as well as the actual incidence of OPF (x2=25.11,P=0.00),the difference was statistically significant.③ 27.3％(18/66) and 55.0％(11/20) of the previous OPF patients in RD group and control group achieved the diagnostic criteria of "high risk" of hip fracture.And 12.1％ (8/66) and 35.0％ (7/20) achieved the "high risk" of major osteoporotic fracture.④ Patients with RA,SLE and pSS had significantly increased risk of fracture.Ten-year fracture risks were negatively related to advanced age,female gender and ESR.Conclusion Bone loss and increased fracture risk are prevalent in the early stage of untreated rheumatism patients.RA,SLE plays an important role in low bone mass.The FRAX China model may underestimate 10-year fracture probability of RD patients and controls.Further explore should be done to predict the FRAX China model on different areas and different RDs.