Recurrent fractures in an elderly patient with systemic lupus erythematosus.
Glucocorticoid-induced osteoporosis (GIO) is an important problem that remains undertreated, even by rheumatologists. We present a case of an elderly patient with systemic lupus erythematosus diagnosed more than 40 years ago, who suffered from recurrent fractures and attendant complications despite a bone mineral density (BMD) score in the osteopenic range and treatment with bisphosphonates. With improved treatment and outcome of lupus, an increasing number of elderly patients who are susceptible to osteoporotic fractures are expected. This case serves to highlight that rheumatic disease patients on steroids should be screened for GIO, as effective treatment and preventive measures are available. Teriparatide is a promising treatment for patients who have failed bisphosphonate treatment or who are at high risk for fracture. We should also bear in mind that BMD scores alone are not indicative of fracture risk, and other tools such as the WHO-FRAX (Fracture risk assessment tool), serum vitamin D3 levels and bone turnover markers should be used where appropriate. Other measures including attention to factors that contribute to falls should also be considered, necessitating a multi-disciplinary approach.
Chia
Faith Li-Ann
FL
Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore.
Thong
Bernard Yu-Hor
BY
Lau
Tang-Ching
TC
Feng
Pao-Hsii
PH
D000368:Aged; D015519:Bone Density / Q000187:drug effects*; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology*; D005938:Glucocorticoids / Q000009:adverse effects; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy* / Q000453:epidemiology; D010024:Osteoporosis / Q000139:chemically induced* / Q000453:epidemiology; D011239:Prednisolone / Q000009:adverse effects*; D012008:Recurrence; D012307:Risk Factors
D005938:Glucocorticoids; D011239:Prednisolone