Incidence of Symptomatic Vertebral Fractures Among Newly Diagnosed Autoimmune Diseases Initiating Glucocorticoid Therapy

Abstract

Few data are available regarding vertebral fracture risk in patients treated with corticosteroids including patients with interstitial lung disease (ILD). The aim of the present study was to identify risk factors for symptomatic vertebral fracture analyzed in patients with newly diagnosed autoimmune diseases.This was an observational cohort study conducted in the National Hospital Organization-EBM study group from 2006 to 2008. The study subjects were autoimmune disease patients who were newly treated with glucocorticoids (GCs). The primary endpoint was the first occurrence of vertebral fracture diagnosed by x-rays. Cox proportional-hazards regression was used to determine independent risk factors for vertebral fracture with covariates including sex, age, comorbidity, laboratory data, use of immunosuppressants, and dose of GCs. Survival was analyzed according to the Kaplan–Meier method and assessed by the log-rank test.Among 604 patients of mean age 59.5 years and mean GC dose 50.4 mg/d (first 1 months), 19 patient (3.1%) had at least 1 symptomatic vertebral fracture during 1.9 years of follow-up period. Cox regression model demonstrated that the relative risk for symptomatic vertebral fracture was independently higher in patient with ILD (hazard ratio [HR] = 2.86, 95% confidence interval [CI] = 1.10–7.42, P = 0.031) and in every 10-year increment of the age of disease onset (HR = 1.57, 95% CI = 1.09–2.26, P = 0.015). Kaplan–Meier analyses demonstrated that the incidence of vertebral fractures in patients with ILD was significantly higher in comparison with those without ILD.Our results indicate a higher risk of vertebral facture in patients with ILD and elderly patients during the initial GC treatment against autoimmune diseases. There is a need for further, even longer-term, prospective studies subjected patients with autoimmune disease, including ILD, under GC treatment.

The role of vertebroplasty in steroid-induced vertebral osteoporotic fractures

“…6 One of the most possible side effects of the usage of glucocorticoids is the trabecular bone mass loss. 11,28 Back pain at different intensities is the main presenting symptom in all patients of G-OVFs. Mild-to-moderate degree of pain in cases of acute vertebral osteoporotic fracture can be relieved by bed rest, bracing, analgesics, anti-osteoporotic drugs (bisphosphonates or denosumab), and anabolic drugs as tripartite (Forteo); 23,38 however, advanced cases with compression fractures mostly need intervention.…”

“…Koch et al 23 and others 9,15 reported that patients with G-OVFs experience levels of pain relief and development of new fractures after PV similar to those with primary osteoporotic vertebral fractures. There was another study 28 stating that adverse effects on bone are mainly due to underlying autoimmune or inflammatory disorders. The previous results support the use of PV to treat OVFs unresponsive to conservative management in patients receiving long-term corticosteroid therapy.…”

Use of corticosteroids is not associated with repeated vertebroplasty or kyphoplasty within one year after the surgery in patient older than 50 years

“…In the literature, some reported that chronic obstructive pulmonary disease, autoimmune disease, collagen vascular disease including systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), Sjogren's syndrome (SS), systemic sclerosis (SSc)/mixed connective tissue disease (MCTD), polymyositis/dermatomyositis (PM/DM), and microscopic polyangiitis are related to the risk of vertebral fractures. 38 , 39 , 40 , 41 But those results are also related to long time steroid usage. In our study, the result showed that those connective tissue disease and chronic lung disease were not associated with repeated PVP or kyphoplasty.…”