Bone Mineral Density, Bone Turnover Markers and Fractures in Patients with Systemic Sclerosis: A Case Control Study

Abstract

ObjectiveThe aim of our study was to elucidate the pathophysiology of systemic sclerosis-related osteoporosis and the prevalence of vertebral fragility fracture in postmenopausal women with systemic sclerosis (SSc).MethodologyFifty-four postmenopausal women with scleroderma and 54 postmenopausal controls matched for age, BMI, and smoking habits were studied. BMD was measured by dual energy-x-ray absorptiometry at spine and femur, and by ultrasonography at calcaneus The markers of bone turnover included serum osteocalcin and urinary deoxypyridinoline. All subjects had a spine X-ray to ascertain the presence of vertebral fractures.Resultsbone mineral density at lumbar spine (BMD 0.78±0.08 vs 0.88±0.07; p<0,001), femoral neck (BMD: 0.56±0.04 vs 0.72±0.07; p<0,001) and total femur (BMD: 0.57±0.04 vs 0.71±0.06; p<0,001) and ultrasound parameter at calcaneus (SI: 80.10±5.10 vs 94.80±6.10 p<0,001) were significantly lower in scleroderma compared with controls; bone turnover markers and parathyroid hormone level were significantly higher in scleroderma compared with controls, while serum of 25(OH)D3 was significantly lower. In scleroderma group the serum levels of 25(OH)D3 significantly correlated with PTH levels, BMD, stiffness index and bone turnover markers. One or more moderate or severe vertebral fractures were found in 13 patients with scleroderma, wherease in control group only one patient had a mild vertebral fracture.ConclusionOur data shows, for the first time, that vertebral fractures are frequent in subjects with scleroderma, and suggest that lower levels of 25(OH)D3 may play a role in the risk of osteoporosis and vertebral fractures.

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

“…However, the relationship between skin involvement and BMD remained uncertain 17 31. Also, previous studies failed to find significant associations between other factors and OF in SSc patients 12 13. Several risk factors for OF, such as propensity of falls, family history of OF, calcium and vitamin D intake, alcohol consumption and smoking status, were also unknown.…”

Association between hypovitaminosis D and systemic sclerosis: True or fake?

“…Lately, Carmel et al reported no correlation between antivitamin D antibodies and some clinical features [18]. Acute-phase reactant including C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR) were extensively investigated in some studies reviewed [11][12][13][14]. Serum calcium, phosphate and bone turnover metabolism were mostly measured in those papers having BMD or parathyroid hormone (PTH) determination in their study protocol [19][20][21].…”

“…Manifold data [9][10][11][12][13] have been provided about the association between low Vitamin D serum levels and clinical features of disease, but few evidences were found to be concordant. Since understanding the pathogenesis implies advances in therapeutic strategies, it is a need to draw conclusions about the role, true or fake, of the hormone, in promoting the onset of SSc.…”

Clinical utilities of quantitative ultrasound in osteoporosis associated with inflammatory rheumatic diseases

“…Bone densitometry utilizing DXA is the most widely used Systemic sclerosis 22% to 60% (spine or hip) (24,25) Systematic vasculitis 14.9% to 85% (spine or hip) (26,27) Juvenile rheumatic diseases 38.7 to 60% (spine or hip) (28)(29)(30) quantitative technique in clinical practice, and remains the gold-standard test for the osteoporosis diagnosis and quantification. Of all modalities, it has the most data on predicting fractures in post-menopausal women in longitudinal population-based studies (41).…”