【狼疮患者骨质疏松和骨折的危险】

慢性肾衰、抗凝及抗癫痫治疗也是狼疮患者骨质疏松和骨折的危险因素

作者：Carli L 翻译：邓晓莉 校正：张警丰 刘湘源
发布者：闫冰 审校者：费雅楠

摘要
骨质疏松和脆性骨折是狼疮患者的并发症之一。本研究目的旨在分析狼疮患者骨质疏松和脆性骨折的患病率并分析相关危险因素。从病历中回顾分析以下资料：年龄、性别、绝经时间、体重指数、吸烟习惯、病程、糖皮质激素的累积用量和每日用量、器官受累类型、伴发疾病和用药情况。同时记录患者骨代谢、钙和维生素D的补充情况、抗骨质疏松药物的使用情况、骨密度及狼疮发病后出现脆性骨折的病史。骨质疏松以及骨量减少按照世界卫生组织的定义进行界定。共纳入186例患者（女性175例，男性11例，平均46.4±13岁，平均病程14.9±9年）。在最后一次随访时，52.2%的患者骨量减少，27.9%的患者骨质疏松。11.8%的患者为女性，有至少一次脆性骨折，其中27.3%为绝经前女性。多因素分析显示，年龄、激素累积用量、绝经、抗癫痫药治疗及慢性肾衰与骨质疏松相关，而年龄、激素累积用量、绝经、慢性肾衰、抗凝药及抗癫痫药与脆性骨折相关。多因素logistic回归模型进一步明确骨质疏松与年龄、绝经及抗癫痫治疗相关，而脆性骨折与年龄、慢性抗凝及抗癫痫治疗相关。结论是，狼疮患者骨量减少常见，脆性骨折也可见于绝经前女性。除年龄、绝经及使用激素等传统危险因素外，慢性肾衰、长期抗凝或抗癫痫治疗也是狼疮患者骨质疏松或脆性骨折的危险因素。

附原文：Abstract：Osteoporosis (OP) and fragility fractures (FFx) are a known comorbidity in patients with systemic lupus erythematosus (SLE). This work aimed at evaluating (1) the prevalence of OP and FFx in a cohort of SLE and (2) the risk factors associated with both OP and FFx. The following data were collected from clinical charts: age, sex, menopausal status (MP), body mass index, smoking habits, disease duration, daily dose and cumulative glucocorticoids (GCs), type of organ involvement, comorbidities and medications. Data on bone metabolism, calcium and vitamin D supplementation and treatment with bisphosphonates, teriparatide or denosumab were collected, together with bone mineral density (BMD) values (measured by dual-energy X-ray absorptiometry (DXA)) and history of FFx (occurred after the onset of SLE and unrelated to trauma). OP and reduced BMD were defined according to the WHO. 186 patients were included (women 175, men 11; mean age 46.4±13 years, mean disease duration 14.9±9 years). At their last visit, 97 patients (52.2%) had a reduced BMD and 52 (27.9%) had OP. 22 patients (11.8%), all women, had at least one FFx; six patients (27.3%) were pre-menopausal. On univariate analysis, age, cumulative dose of GC, MP, therapy with antiepileptics and chronic renal failure (CRF) were correlated with OP (p<0.03); age, total amount of GC, MP, CRF, anticoagulants (AC) and antiepileptic therapy were correlated with FFx (p<0.05). The multivariate logistic model confirmed a direct association of OP and age, MP and antiepileptic therapy (p≤0.01) and of FFx and age, chronic therapy with AC and antiepileptics (p<0.03). In conclusion, low BMD is frequently observed in SLE, and FFx are observed also in premenopausal patients. Together with traditional risk factors (age, MP and GC), CRF and chronic treatments with AC or antiepileptics seem to be associated with a higher risk profile for OP and FFx occurrence.

引自：
Carli L, Tani C, Spera V, Vagelli R, Vagnani S, Mazzantini M, Di Munno O, Mosca M. Risk factors for osteoporosis and fragility fractures in patients with systemic lupus erythematosus.Lupus Sci Med. 2016 Jan 19;3(1):e000098. doi: 10.1136/lupus-2015-000098. eCollection 2016.