Self-reported fractures and associated factors in women with systemic lupus erythematosus.
OBJECTIVE
To determine the frequency of fractures and associated factors in women with systemic lupus erythematosus (SLE).


METHODS
Women with SLE (n = 304) completed this cross-sectional study conducted from 1996 to 2002. Self-reported fractures occurring after the diagnosis of SLE were evaluated. Hip and/or lumbar spine bone mineral density (BMD) was measured using dual-energy x-ray absorptiometry, and the results were expressed as BMD Z-scores. Multiple logistic regression analyses were performed to identify factors associated with fractures.


RESULTS
Of the 304 women with SLE, 12.5% experienced fractures. Those with fractures had significantly lower BMD Z-scores at the hip (Fracture group -0.55 vs No Fracture group -0.14, group difference 0.41; 95% CI 0.04 to 0.78), but not at the lumbar spine (Fracture group -0.25 vs No Fracture group -0.18, group difference 0.07; 95% CI -0.43 to 0.57). Among women with fractures, 60.5% and 63.2% had normal BMD Z-scores (BMD Z-score > -1.0) at the hip and lumbar spine, respectively, and 50.0% had normal BMD Z-scores at both anatomical sites. In multiple logistic regression analysis, each year of disease duration (adjusted OR 1.11; 95% CI 1.05 to 1.17) and use of osteoporosis medications (adjusted OR 4.75; 95% CI 1.62 to 13.94) were significantly associated with fractures.


CONCLUSIONS
. Longer duration of SLE and use of osteoporosis medications were significantly associated with fractures. Although women with fractures had significantly lower BMD Z-scores at the hip, an unexpectedly high proportion of women with SLE having normal BMD Z-score experienced fractures following SLE diagnosis.
Lee
Chin
C
Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60611, USA. c-lee17@northwestern.edu
Almagor
Orit
O
Dunlop
Dorothy D
DD
Manzi
Susan
S
Spies
Stewart
S
Ramsey-Goldman
Rosalind
R
D000293:Adolescent; D000328:Adult; D015519:Bone Density; D003430:Cross-Sectional Studies; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000503:physiopathology; D008875:Middle Aged; D010024:Osteoporosis / Q000503:physiopathology; D012044:Regression Analysis; D012307:Risk Factors; D016353:Self-Examination