Bone mineral density in patients with scleroderma systematica


Cite item

Abstract

Aim. To study the frequency and magnitude of a reduction in bone mineral density (BMD) and its association with clinical parameters in patients with scleroderma systematica (SDS). Subjects and methods. Fifty-six postmenopausal women aged 45-71 years (58.1±7.1 years) with a valid diagnosis of SDS and 44 age-matched healthy women were examined. Dual-energy X-ray absorptiometry (Hologic QDR 4500, Waltham, MA) was performed in all the included patients to measure BMD in the lumbar spine (LI—LIV), femoral neck, and proximal femur. Results. The patients with SDS and the healthy women showed no differences in body mass index (BMI) (24.7±4.6 and 25.7±3.5 kg/m2, respectively) and postmenopause duration (9.6±6.4 and 9.5±7.0 years, respectively); menopause occurred earlier in the patients with SDS than in the healthy women (46.9±3.6 and 49.7±3.0 years, respectively (p<0.001). The patients with SDS versus the controls had a significantly lower BMD in the lumbar spine (0.821±0.121 and 0.861±0.092 g/cm2; р<0.05), femoral neck (0.620±0.129 and 0.736±0.112 g/cm2; p<0.0001), and proximal femur (0.736±0.148 and 0.884±0.124 g/cm2; р<0.0001). Osteoporosis (OP) was detected in 29 (52%) of the 56 patients and in only 5 (11%) of the 44 control women (р<0.0001). The patients with diffuse SDS displayed a much greater reduction in BMD in all the regions than those with circumscribed SDS. BMD was significantly lower in the patients treated with glucocorticosteroids (GCS) than in the untreated ones. In the control group, BMD was associated with age, duration of menopause, and BMI. In the patients with SDS, BMD was correlated with BMI and inversely correlated with duration of menopause, and the magnitude of a BMD reduction was closely related to disease duration. The patients also showed an inverse correlation of BMD with the daily dose of GCS. Conclusion. The postmenopausal women with SDS were found to have a lower BMD in 80% of cases. In this category of women, the reduction in BMD was significantly commoner and more pronounced than in the age-matched healthy women. Low BMI, diffuse SDS, disease duration, and GCS use are risk factors for reduced BMD and OP.

References

  1. Гусева Н.Г. Системная склеродермия и псевдосклеродермические синдромы. М.: Медицина; 1993.
  2. Lorand V, Czirjak L, Minier T. Musculoskeletal involvement in systemic sclerosis. Presse Med. 2014;43(10,Pt 2):315-328. doi: 10.1016/j.lpm.2014.03.027.
  3. Tedeschini E, Pingani L, Simoni E, Ferrari D et al. Correlation of articular involvement, skin disfigurement and unemployment with depressive symptoms in patients with systemic sclerosis: a hospital sample. Int J Rheum Dis. 2014;17(2):186-194. doi: 10.1111/1756-185X.12100.
  4. La Montagna G, Vatti M, Valentini G, Tirri G. Osteopenia in systemic sclerosis. Evidence of a participating role of earlier menopause. Clin Rheumatol. 1991;10(1):18-22. doi: 10.1007/bf02208027.
  5. Di Munno O, Mazzantini M, Massei P, Ferdeghini M, Pitaro N, Latorraca A, Ferri C. Reduced bone mass and normal calcium metabolism in systemc sclerosis with and without ncalcinosis. Clin Rheumatol. 1995;14(4):407-412. doi:10/1007/bf02207673.
  6. Carbone L, Tylavsry F, Wan J, McKown K, Cheng S. Bone mineral density in scleroderma. Rheumatology (Oxford). 1999;38(4): 371-372. doi: 10.1093/rheumatology/38.4.371.
  7. Souza RB, Borges CT, Takayama L, Aldrighi JM, Pereira RM. Systemic sclerosis and bone loss: the role of disease and body composition. Scand J Rheumatol. 2006;35(5):384-387. doi: 10.1080/03009740600704296.
  8. da Silva HC, Szejnfeld VL, Assis LS, Sato EI. Study of bone density in systemic sclerodermа. Rev Assos Med Bras. 1997;43(1):40-46. doi: 10.1590/s0104-42301997000100010.
  9. Van Den Hoogen F, Khanna D, Fransen J, Johnsosn SR, Baron M, Tyndall A, Matucci M, Naden R, Pope J. on behalf of all experts committed to the working group for Classification Criteria for SSc. Classification criteria for systemic sclerosis: preliminary results. Ann Rheum Dis. 2013;72(Suppl3):A59. doi: 10.1136/annrheumdis-2013-eular.238.
  10. LeRoy EC, Black C, Fleischmajer R, Jablonska S, Krieg T, Medsger TA Jr, Rowell N, Wollheim F. Scleroderma (systemic sclerosis): classification, subsets and pathogenesis. J Rheumatol. 1988;15(2):202-205.
  11. Kanis JA. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO study Group. Osteoporos Int. 1994;4:368-381. doi: 10.1007/BF01622200.
  12. Frediani B, Baldi F, Falsetti P, Acciai C, Filippou G, Spreafico A, Chellini F, Capperucci C, Filipponi P, Galeazzi M, Marcolongo R. Bone mineral density in patients with systemic sclerosis. Ann Rheum Dis. 2004;63:326-327. doi: 10.1136/ard.2003.011064.
  13. Sampaio-Barros PD, Costa-Paiva L, Filardi S, Sachetto Z, Samara AM, Marques-Neto JF. Prognostic factors of low bone mineral density in systemic sclerosis. Clin Exp Rheumatol. 2005;23(2):180-184. doi: 10.1007/s10067-004-0961-0.
  14. Avouc J, Koumakis E, Toth E, Meunier M et al. Increased risk of osteoporosis and fracture in women with systemic sclerosis: a comparative study with rheumatoid arthritis. Arthritis Care Res (Hoboken). 2012;64(12):1871-1878. doi: 10.1002/acr.21761.
  15. Kilic G, Kilic E, Akgol O, Ozgocmen S. Increased risk for bone loss in women with systemic sclerosis: a comporative study with rheumatoid arthritis. Int J Rheum Dis. 2013. doi: 10.1111/1756-185X.12242.
  16. Marot M, Valéry A, Esteve E, Bens G, Müller A, Rist S, Toumi H, Lespessailles E. Prevalence and predictive factors of osteoporosis in systemic sclerosis patients: a case-control study. Oncotarget. 2015;6(17):14865-14873. doi: 10.18632/oncotarget.3806.
  17. Mok CC, Chan PT, Chan KL, Ma KM. Prevalence and risk factors of low bone mineral density in Chinese patients with systemic sclerosis: a case-control study. Rheumatology(Oxford). 2013;52(2): 296-303. doi: 10.1093/rheumatology/kes240.
  18. Omair MA, Pagnoux C, McDonald-Blumer H, Johnson SR. Low bone density in systemic sclerosis. A systematic review. J Rheumatol. 2013;40(11):1881-1890. doi: 10.3899/jrheum.130032.
  19. Ibn Yacoub Y, Amine B, Laatiris A, Wafki F, Znat F, Hajjaj-Hassouni N. Bone density in Morrocan women with systemic scleroderma and its relationship with disease-related parameters and vitamin D status. Rheumatol Int. 2012;32(10):3143-3148. doi: 10.1007/s00296-011-2150-1.
  20. Ревматология: национальное руководство. Под ред. Насонова Е.Л., Насоновой В.А. М.: ГЭОТАР-Медиа; 2008.
  21. Omair MA, McDonald-Blumer H, Johnson SR. Bone disease in systemic sclerosis: outcomes and associations. Clin Exp Rheumatol. 2014;32(6)(Suppl 86):28-32. doi: 10.2899/jrheum.130032.
  22. Maruotti N, Corrado A, Cantatore FP. Osteoporosis and rheumatic disease. Reumatismo. 2014;66(2):125-135. doi: 10.4081/reumatismo.2014.785.
  23. Ferrari SL. Ahn-Luona L, Garnero P et al. Two promoter polvmorphisms regulating interleukin-6 gene expression are associated with circulating levels of C-reactive protein and markers of bone resorption in postmenopausal women. J Clin Endocrinol Metab. 2003;88:255-259. doi: 10.1210/jc.2001-020092.
  24. Jilka RL, Hangoc C, Girasole G et al. Increased osteoclast development after estrogen loss: Mediation by interleukin-6. Science. 1992;257:88-91. doi: 10.1126/science.1621100.
  25. Scheidt-Nave C, Bismar H, Leidig-Bruckner G et al. Serum Interleukin-6 is a major predictor of bone loss in women specific to the first decade past menopause. J Clin Endocrinol Metab. 2001;86:2032-2042. doi:10/1210/jcem.86.5.7445.
  26. Pereira RMR, Carvalho JF, Canalis E. Glucocorticoid-induced osteoporosis in rheumatic diseases. Clinics. 2010;65(11):1197-1205. doi: 10.1590/s1807-59322010001100024.
  27. van Staa TP, Leufkens HG, Cooper C. The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis. Osteoporos Int. 2002;13:777-787. doi: 10.1007/s001980200108
  28. Atteritano M, Sorbara S, Bagnato G, Miceli G, Sangari D et al. Bone Mineral Density, Bone Turnover Markers and Fractures in Patients with Systemic Sclerosis: A Case Control Study. PLoS ONE. 8(6). doi: 10.1371/journal.pone.0066991.
  29. Lai СС, Wang SH, Chen WS, Liu CJ, Chen YJ, Lee PC, Chang YS. Increased risk of osteoporotic fractures in patients with systemic sclerosis: a nationwide population-based study. Ann Rheum Dis. 2015;74(7):1347-1352. doi: 10.1136/annrheumdis-2013-204832.

Copyright (c) 2016 Alekperov R.Т., Smirnov A.V., Toroptsova N.V., Kudinsky D.M.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 

Address of the Editorial Office:

  • Novij Zykovskij proezd, 3, 40, Moscow, 125167

Correspondence address:

  • Alabyan Street, 13/1, Moscow, 127055, Russian Federation

Managing Editor:

  • Tel.: +7 (926) 905-41-26
  • E-mail: e.gorbacheva@ter-arkhiv.ru

 

© 2018-2021 "Consilium Medicum" Publishing house


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies