title: Prevalence and predictors of fragility fractures in systemic lupus erythematosus.
abstract: OBJECTIVE
  To establish the prevalence of reduced bone mineral density (BMD) and fractures, and risk factors for fractures, in a cross sectional study of a large cohort of patients with systemic lupus erythematosus (SLE).
  
  
  METHODS
  All SLE patients willing to take part in the study had bone densitometry in 1999/2000 and completed a questionnaire on risk factors for osteoporosis and on drugs used. Accumulated damage was scored using the SLICC/ACR damage index (SDI). Only fractures occurring since the onset of SLE and unrelated to trauma were included, and the SDI score was modified to exclude osteoporotic fractures. Statistical analysis was by chi(2) test, Fisher's exact test, and binary logistic regression.
  
  
  RESULTS
  242 patients were studied, median age 39.9 years (range 18 to 80), median disease duration 7.0 years (range 0 to 42). Of these, 123 (50.8%) had reduced BMD (T score <-1.0) and 25 (10.3%) were in the osteoporotic range (T score <-2.5). Fragility fractures had occurred in 22 patients (9.1%) since diagnosis of SLE. Of these, two (9.1%) had normal BMD and 20 (90.9%) had reduced BMD, while seven (31.8%) were within the osteoporotic range. Non-Afro-Caribbean race and exposure to prednisolone >10 mg daily were significantly associated with reduced BMD, while age and menopause were associated with osteoporosis. The risk factors for fractures were reduced BMD and age.
  
  
  CONCLUSIONS
  Reduced BMD, osteoporosis, and fragility fractures appear to be prevalent in patients with SLE. Steroids were not an independent risk factor for fractures, although their effect could be mediated through reduced bone mineral density.
authors.affiliation: Department of Rheumatology, University of Birmingham, Birmingham B15 2TT, UK.
authors.forename: C-S
authors.initials: CS
authors.lastname: Yee
authors.forename: N
authors.initials: N
authors.lastname: Crabtree
authors.forename: J
authors.initials: J
authors.lastname: Skan
authors.forename: N
authors.initials: N
authors.lastname: Amft
authors.forename: S
authors.initials: S
authors.lastname: Bowman
authors.forename: D
authors.initials: D
authors.lastname: Situnayake
authors.forename: C
authors.initials: C
authors.lastname: Gordon
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D003430:Cross-Sectional Studies; D004739:England / Q000453:epidemiology; D005260:Female; D050723:Fractures, Bone / Q000208:ethnology / Q000209:etiology*; D005938:Glucocorticoids / Q000009:adverse effects; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000208:ethnology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000208:ethnology / Q000209:etiology*; D011239:Prednisolone / Q000009:adverse effects; D015995:Prevalence; D012307:Risk Factors
chemical_list: D005938:Glucocorticoids; D011239:Prednisolone