P151 Prevalence and risk factors of osteoporosis in Indian systemic sclerosis patients

Abstract

Background/Aims Systemic sclerosis (SSc) is a systemic autoimmune disease in which osteoporosis has been reported to be more prevalent than in healthy individuals. Bone loss is hypothesised to be related to vasculopathy in SSc, but the causative pathways are not very clear. This study was conducted to investigate the prevalence of osteoporosis in Indian patients with SSc and to assess its association with various disease-related characteristics. Methods This was a cross-sectional, case-control study performed in a 1,250 bedded tertiary care hospital. Between August 2017 and June 2019, all consecutive patients attending the outpatient and in-patient departments of the Department of Rheumatology & Clinical Immunology at our institute, classified as SSc as per the ACR/EULAR 2013 criteria, were included after taking their informed consent. Age and gender-matched healthy controls were included and all enrolled subjects were subjected to a dual energy X-ray absorptiometry (DEXA) scan. Demographic and clinical details of all patients were recorded. Osteoporosis was defined as per the WHO definition of a T score ≤ -2.5. The study was approved by the Institutional Review Board and the Institutional Ethics Committee. Results 90 patients with SSc and 45 age and gender-matched healthy controls were included in the study. Confounding factors for bone health, like smoking or alcohol intake, the proportion of post-menopausal women, and past or family history of fragility fractures, were matched between the two groups. The prevalence of osteoporosis among SSc cases was significantly higher than in the healthy controls (34.4% vs. 6.6%, p < 0.001). In univariate analysis, age, low body mass index (BMI), post-menopausal status, diffuse cutaneous phenotype, gastrointestinal involvement, digital ulcers, and pulmonary arterial hypertension were found to be significantly associated with osteoporosis. Multivariate analysis revealed that the presence of osteoporosis was significantly associated with lower BMI, post-menopausal status, and the presence of digital ulcers in patients. Interestingly, glucocorticoid use did not appear to increase the risk of osteoporosis in our cohort. Conclusion Patients with systemic sclerosis and digital ulcers, low BMI, or post-menopausal status are at high risk of developing osteoporosis and therefore should be screened for osteoporosis by DEXA scan to prevent unforeseen fracture-related morbidity and mortality. Glucocorticoids may not be the major culprit as evidenced by this study, while control of disease activity may lead to better bone health status. Disclosure D. Tanna: None. S. Ghosh: None. K. Telang: None. G. Ekbote: None. V. Singal: None. R. Gupta: None.