Association of Systemic Lupus Erythematosus With a Higher Risk of Cervical but Not Trochanteric Hip Fracture: A Nationwide Population‐Based Study

Abstract

Objective. To determine the incidence rates and risk factors of cervical and trochanteric hip fractures (HFs) among patients with systemic lupus erythematosus (SLE) based on a nationwide population-based data set. Methods. We conducted a cohort study using data from the Taiwan National Health Insurance database. Patients with SLE and their age-and sex-matched counterparts without SLE were identified. The primary end point was the first occurrence of HF. Cox proportional hazards model was used to evaluate the respective risk factors of cervical and trochanteric HFs in the lupus cohort. Results. Among 14,544 patients with SLE (90% women, mean age 38.1 years) with a mean followup of 6 years, 75 developed HF (incidence rate 8.60 per 10,000 person-years). Compared to controls, the incidence rate ratios (IRRs) for developing HF among lupus patients were 3.17 (95% confidence interval [95% CI] 1.92-5.39, P < 0.001) for cervical HF and 1.11 (95% CI 0.58 -2.11, P ‫؍‬ 0.571) for trochanteric HF. The IRRs for HF were 2.38 (95% CI 1.58 -3.63, P < 0.001) for women and 1.06 (95% CI 0.21-4.93, P ‫؍‬ 0.922) for men. Lupus patients with cervical HF were younger than controls with cervical HF (mean age 56.7 versus 67.8 years; P ‫؍‬ 0.007). Multivariable Cox regression analyses showed that age, use of intravenous cyclophosphamide, higher dose of steroid, and stroke were associated with cervical HF, whereas age was the only associated factor for trochanteric HF. Conclusion. SLE is associated with a higher risk for cervical but not trochanteric HF, and these 2 types of HFs have different risk factors.

Lupus and fractures

“…Age, longer disease duration, previous glucocorticoid use, and previous fractures were identified as independent risk factors for symptomatic fractures [2, 4,5]. Furthermore, the study [5] from the UK reported a high fracture risk in patients with seizures or a past cerebrovascular event, which finding is confirmed by a nationwide study [16] on hip fractures in Taiwan, which demonstrated that SLE patients with a history of stroke had a 2.3-foldincreased risk (hazard ratio 2.29, 95% CI 1.02-5.15) of femoral neck fracture compared with patients without stroke. The increased fracture occurrence in patients with seizures or a past cerebrovascular event might be because of an increased risk of falls in these subgroups of patients and/or by the adverse effect of anticoagulants and antiepileptic drugs on bone mass, but could also be regarded as an indicator of disease severity.…”

“…A recent cohort study [17 & ] from Italy indeed reported chronic use of anticoagulants and use of antiepileptic drugs as independent risk factors for symptomatic fractures in patients with SLE. The study [16] from Taiwan also identified previous intravenous cyclophosphamide use as an independent risk factor for femoral neck fracture in SLE. This association might be explained by cyclophosphamideinduced premature ovarian failure, which in turn induces osteoporosis and an increased fracture risk.…”

A Systematic Review and Meta-analysis of the Association Between Vitamin K Antagonist Use and Fracture

“…The characteristics of included studies are outlined in Table 1. Twenty-two of the 23 studies were observational: 8 prospective cohort studies, 22,23,27,33,[35][36][37][38] 7 retrospective cohort studies, 16,18,21,24,25,28,30 3 case control studies, 19,31,32 and 4 cross-sectional studies. 17,20,26,29 One study was a randomized controlled trial.…”

“…Sub-analysis of Odds of Fracture in VKA Users Versus ControlsHip fracture16,18,21,27,32,33,[36][37][38] 0.91 (0.69, 1.20) 85 Vertebral fracture…”

Increased risk of osteoporotic fractures in patients with systemic sclerosis: a nationwide population-based study

“…Prokinetic drugs, including oral metoclopramide, mosapride, domperidone and intravenous metoclopramide, were identified as markers of potential SSc-related bowel dysmotility and malabsorption, which is associated with bone loss in female SSc patients 15. Medications for treating osteoporosis were excluded from the analysis to prevent potential susceptibility bias and misinterpretation, as described previously 23. To analyse the effect of steroids on OF, cumulative doses and the mean daily dose of oral corticosteroids (prednisolone or its equivalent) were identified.…”