AB0619 Many peripheral fractures despite normal bone mineral densityin caucasian sle patients
Authors: R. Biesen, E. Wiebe, D. Freier, K. Zeiner, U. Schneider, T. Alexander, F. Hiepe, F. Buttgereit
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Clinical outcome has improved in systemic lupus erythematosus (SLE) and thus, early management of comorbidities like cardiovascular disease and osteoporosis has become highly important. In this disease, osteoporotic risk factors such as female gender, early onset of disease leading to long disease duration, high degree of systemic inflammation, high frequencies of glucocorticoid usage often at higher doses, and chronic fatigue or pain compromising physical activities are often present in combination.<sup>1</sup> Rh-GIOP (NCT02719314) is an ongoing prospective study monitoring glucocorticoid (GC)-induced osteoporosis of rheumatic patients, established in 2015 at the Charité University Hospital. To date, the database comprises clinical data and bone mineral density data measured by dual x-ray absorptiometry (DXA) of 592 patients with inflammatory rheumatic diseases. <h3>Objectives</h3> To quantify bone mineral density and fractures in SLE patients. <h3>Methods</h3> Bone mineral density (BMD) data of SLE patients as measured by dual x-ray absorptiometry (DXA) were analysed with regard to their relation to detailed clinical data. <h3>Results</h3> 43 female and 6 male SLE patients aged between 20 and 77 years (mean: 46.31 years) were assessed by DXA (all of Caucasian ethnicity, mean disease duration: 15.49 years; 61% denied any physical activity). SLE medication included glucocorticoids (93.9%; mean cumulative dose: 25.5 g), antimalarials (67.3%), azathioprine (30.6%), mycophenolate-mofetil acid (22.4%), belimumab (16.3%), cyclophosphamide (10.2%) and methotrexate (8.1%). In 26 (60,5%) of all studied SLE patients, 36 (92.3%) peripheral and 3 (7.7%) vertebral fractures were recorded. Notably, 6 of these patients with fractures were younger than 30 and only 4 older than 60 years. 10 of all 39 fractures (25.6%) were low-trauma fractures. Of note, 11/26 patients (42.3%) with fractures had a normal BMD, 9/26 (34.6%) osteopenia and 6/26 (23.7%) osteoporosis, while only 4 (15.4%) of them initially received anti-osteoporotic medication. <h3>Conclusions</h3> There is a high occurrence of peripheral fractures in SLE. Moreover, 4 out of 10 SLE patients developed fractures despite a normal BMD, stressing that this parameter is of limited value for correctly identifying the fracture risk in SLE. The analysis of a larger number of patients and in-depth analyses are necessary to improve management of osteoporosis and to better prevent fractures in SLE patients. <h3>Reference</h3> [1] "<i>Bone Disease in Connective Tissue Disease/Systemic Lupus Erythematosus."</i> Bultink IEM. Calcif Tissue Int. 2017Sep 12 <h3>Disclosure of Interest</h3> R. Biesen Grant/research support from: Amgen, BMS, Celgene, Generic Assays GSK, Horizon, medac, Mundipharma, Pfizer and Roche, E. Wiebe Grant/research support from: Amgen, BMS, Celgene, Generic Assays GSK, Horizon, medac, Mundipharma, Pfizer and Roche, D. Freier Grant/research support from: Amgen, BMS, Celgene, Generic Assays GSK, Horizon, medac, Mundipharma, Pfizer and Roche, K. Zeiner Grant/research support from: Amgen, BMS, Celgene, Generic Assays GSK, Horizon, medac, Mundipharma, Pfizer and Roche, U. Schneider: None declared, T. Alexander: None declared, F. Hiepe: None declared, F. Buttgereit Grant/research support from: Amgen, BMS, Celgene, Generic Assays GSK, Horizon, medac, Mundipharma, Pfizer and Roche