Fracture Risk Assessment In Female Patients with Systemic Lupus Erythematosus

Abstract

Assessment of fracture risk in SLE patients deserves special attention because fractures may occur while their BMD is above the osteoporotic threshold or even at the normal range. As BMD alone furnishes little information on bone quality and there are several other independent clinical and demographic factors related to fractures which cannot be totally reflected by LBMD Recently, FRAX was developed to calculate age-specific fracture probabilities on the basis of clinical risk factors and the BMD at the FN. Treatment of osteoporosis should be considered for patients with LBMD and a ten-year risk of hip fracture of ≥3% or a ≥20% ten-year risk of a major osteoporosis-related fracture, as assessed with FRAX (Matikainen, 2016). Measurements of biochemical bone marker levels can be used not only to monitor treatment efficacy but also to assess fracture risk and help select patients for therapy (Wheater et al 2013). Our study was done on 70 Egyptian SLE patientsaged ≥ 40 years according to FRAX recommendations. All patients were subjected to the following: full history taking and thorough clinical examination, BMI measurement, assessment of disease activity and disease damage by SLEDAI score and (SLICC/ACR) damage index respectively, routine laboratory investigations, ESR, urine analysis, protein creatinine ratio, serum calcium level, serum phosphorus level, serum alkaline phosphatase level, serum C3,C4 level, Anti-ds DNA titres. Also investigations for assessment of BMD and bone turnover: (DEXA) scan on (L2 to L4) and neck femur, Serum Osteocalcin level as a bone turn over marker and WHO risk assessment tool (FRAX ®). In our study, we demonstrated that SLE patients are at a great risk of developing osteopenia and osteoporosis and subsequently higher fracture risk. In our group of SLE patients, age, disease duration, systemic inflammation, disease damage, premature menopause and glucocorticoid treatment (mean daily dose, IV methylpredinisone, and cumulative dose) were the major risk factors for bone loss. Also, There was also inverse correlation between BMD at any region and various medications used as cyclophosphamide, azathioprine, PPI, SSRI, anticoagulants. Significantly lower BMDs were found in those who were not on calcium and vitamin D supplements, than SLE patients who were on calcium and vitamin D. Our results also show that serum osteocalcin levels were lower in patients with LBMD especially osteoporotics. These results show that patients with the previous risk factors for bone loss had a higher ten-year risk of hip fracture and a higher ten-year risk of a major osteoporosis-related fracture as assessed with FRAX according to NOF guidelines. Our results also concluded that FRAX predicted incident hip and major osteoporotic and fractures among SLE patients with normal and low bone mass not just those with frank osteoporosis, this is important because the majority of fragility fractures in the population affect osteopenic not osteoporotic patients. If physicians can identify patients at risk for fracture, prevention programs may be initiated to reduce the number of fractures sustained.