Factors Associated With Development of Osteoporosis and Fragility Fractures in Primary Sjögren Syndrome

Patients with primary Sjögren syndrome (pSS) may develop osteoporosis and fragility fractures during the course of their disease; age, disease duration and activity, and corticosteroid treatment were found to be associated with the development of osteoporosis in pSS, according to study results published in Rheumatology International.

The clinical characteristics and patient demographics of pSS suggest that these patients may be at increased risk for osteoporosis. Using data from the SJOGRENSER registry, a cross-sectional study of patients with pSS developed according to the American European consensus, the investigators aimed to determine the prevalence and factors associated with the development of osteoporosis in patients with pSS.

The study cohort included 437 patients (median age, 58.6 years) who were predominantly women (95%), of whom 76.4% were menopausal. The prevalence of osteoporosis in the cohort was 18.54% and similar among both men and women. Of the women who were menopausal, 15% also had osteoporosis.

Compared with patients without osteoporosis, in menopausal women with osteoporosis, pSS was associated with age (P <.001), disease duration (P <.001), age of menopause (P =.020), EULAR Sjögren’s Syndrome Disease Activity Index (P =.020), the presence of anti-La antibodies (P =.030), and corticosteroid treatment, both past (P =.001) and present (P =.013).

Multivariate analysis revealed an association between osteoporosis and age in both the 51 to 64-year menopausal age group (odds ratio [OR], 9.99; 95% CI, 2.30-43.40; P =.002) and the >64 years age group (OR, 20.61; 95% CI, 4.68-90.77; P <.001). Osteoporosis was also associated with disease duration (OR, 1.05; 95% CI, 1.01-1.09; P =.017) and prior treatment with corticosteroids (OR, 2.55; 95% CI, 1.27-5.11; P =.008).

In the entire cohort, researchers recorded 37 fragility fractures. In postmenopausal women, an association with fracture risk was identified for age in the 51 to 64-year (OR, 5.07; 95% CI, 1.11-23.00; P =.035) and >64-year age groups (OR, 7.67; 95% CI, 1.68-35.15; P <.009), disease duration (OR, 1.05; 95% CI, 1.00-1.01; P =.036), and EULAR Sjögren’s Syndrome Disease Activity Index (OR, 1.08; 95% CI, 1.03-1.13; P =.02).

Researchers noted that the lack of certain laboratory parameters related to osteoporosis, including calcium and vitamin D levels and bone density, represented a limitation of the study.

“Clinicians should be aware of these findings, which underline the importance of prevention and treatment of [osteoporosis] and fragility fractures in patients with pSS,” the researchers concluded.

Reference

Salman-Monte TC, Sanchez-Piedra C, Fernandez Castro M, et al. Prevalence and factors associated with osteoporosis and fragility fractures in patients with primary Sjögren syndrome. Rheumatol Int. 2020;40(8):1259-1265.