Rates of bone density screening and osteoporosis in Scleroderma-Are we doing enough?.

Abstract

Aim: Although evidence suggests that bone mineral density is decreased in patients with systemic sclerosis (SSc), no guidelines exist regarding appropriate screening of SSc patients for osteoporosis. Additionally, the risk factors and associations of osteoporosis in patients with SSc are poorly understood. We sought to report the rates of dual-energy x-ray absorptiometry (DEXA), osteoporosis, fracture and osteoporosis therapy in a large cohort of patients with SSc at Monash Medical Centre and to establish determinants of bone density in these patients. Method(s): Retrospective chart review was performed of all patients recruited in the Australian Scleroderma Cohort Study between September 2007 and December 2018. T scores in lumbar spine and femoral neck of DEXAs were recorded along with history of fractures and osteoporosis therapy. Demographic and disease features were compared between patients with osteoporosis, osteopenia and normal bone densities using the chi-square test for categorical variables and independent t-test for continuous variables. P-values <0.05 were considered significant. Result(s): DEXAs were performed in 104 (43%) of 244 patients during the study period. Of patients with available T-scores, osteoporosis was present in 30 (33%) and osteopenia in 48 (53%). There was a trend towards older age (65.0 vs 59.5 years, P = 0.065) though not towards longer disease duration in patients with osteoporosis. Patients with osteoporosis were more likely to have been treated with prednisolone (P = 0.005) and there was a trend towards malabsorption (P = 0.061). Patients without DEXAs were more likely male (P = 0.04) and younger (59.5 vs 65.9 years, P = 0.0006). Across the cohort, at least one fracture occurred in 23 (9%) patients and 38 (16%) patients were treated with osteoporosis therapies. Conclusion(s): In our cohort of SSc patients, osteoporosis occurred frequently and was associated with prednisolone use. Screening for osteoporosis seems indicated in these patients but the ideal group of SSc patients to target warrants further investigation.