Abstract
ObjectiveThe aim of our study was to elucidate the pathophysiology of systemic sclerosis-related osteoporosis and the prevalence of vertebral fragility fracture in postmenopausal women with systemic sclerosis (SSc).MethodologyFifty-four postmenopausal women with scleroderma and 54 postmenopausal controls matched for age, BMI, and smoking habits were studied. BMD was measured by dual energy-x-ray absorptiometry at spine and femur, and by ultrasonography at calcaneus The markers of bone turnover included serum osteocalcin and urinary deoxypyridinoline. All subjects had a spine X-ray to ascertain the presence of vertebral fractures.Resultsbone mineral density at lumbar spine (BMD 0.78±0.08 vs 0.88±0.07; p<0,001), femoral neck (BMD: 0.56±0.04 vs 0.72±0.07; p<0,001) and total femur (BMD: 0.57±0.04 vs 0.71±0.06; p<0,001) and ultrasound parameter at calcaneus (SI: 80.10±5.10 vs 94.80±6.10 p<0,001) were significantly lower in scleroderma compared with controls; bone turnover markers and parathyroid hormone level were significantly higher in scleroderma compared with controls, while serum of 25(OH)D3 was significantly lower. In scleroderma group the serum levels of 25(OH)D3 significantly correlated with PTH levels, BMD, stiffness index and bone turnover markers. One or more moderate or severe vertebral fractures were found in 13 patients with scleroderma, wherease in control group only one patient had a mild vertebral fracture.ConclusionOur data shows, for the first time, that vertebral fractures are frequent in subjects with scleroderma, and suggest that lower levels of 25(OH)D3 may play a role in the risk of osteoporosis and vertebral fractures.
Highlights
Systemic sclerosis (SSc) is a chronic disease characterized by increased synthesis and deposition of collagen in skin and connective tissue, vascular alteration and immunological disturbances
Our data shows, for the first time, that vertebral fractures are frequent in subjects with scleroderma, and suggest that lower levels of 25(OH)D3 may play a role in the risk of osteoporosis and vertebral fractures
The results show that women with systemic sclerosis have a statistically significant lower BMD and T-score, measured at lumbar spine (BMD: 0.7860.08 g/cm2 vs 0.8860.07 g/cm2 p,0.001; T-score: 22.2060.30 g/cm2 vs. 21.2060.30 g/cm2, p,0.001), femoral neck (BMD: 0.5660.04 g/cm2 vs. 0.7260.07 g/cm2, p,0.001; T-score: - 2.6060.20 g/cm2 vs. 21.3060.30 g/cm2, p,0.001) and total femur (BMD: 0.5760.04 g/cm2 vs. 0.7160.06 g/cm2, p,0.001; T-score: 22.5060.30 g/cm2 vs. 21.4060.30 g/cm2, p,0,001)
Summary
Systemic sclerosis (SSc) is a chronic disease characterized by increased synthesis and deposition of collagen in skin and connective tissue, vascular alteration and immunological disturbances. Was demonstrated that SSc itself is a risk factor for osteoporosis [1]. Several other studies had observed a relationship between low bone density and systemic sclerosis [2,3,4]. Low bone density is associated with a greater risk of fragility fractures. Caramaschi P et al have described that SSc patients with vitamin D deficiency showed more severe disease in comparison with SSc patients with vitamin D insufficiency [17]. It is possible that vitamin D represent a factor which play a role on bone loss and fracture risk in scleroderma patients. The aim of our study was to determine the prevalence of osteoporosis and fragility fracture in SSc patient
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