Bone mineral density in patients with systemic scleroderma
Objective: to assess the frequency of a reduction in bone mineral density (BMD) and its association with traditional risk factors and clinical parameters in patients with systemic scleroderma (SSD). Patients and methods. The investigation included 330 people: 190 patients (median age 55 [41; 61.5] years) with SSD and 140 control individuals (median age 57 [40.5; 66] years without a history of inflammatory rheumatic diseases. The patients were interviewed using a uniform questionnaire; dual-energy X-ray absorptiometry was used to measure BMD in the lumbar spine (L-iv), femoral neck (FN), entire proximal femur (PF), and distal third of the forearm (DTF). The concentration of 25(OH)D was measured in 155 examinees. Results and discussion. Decreased BMD was found in 69% of patients with SSD and in 58% of controls (p=0.0392), including osteoporosis (OP) in 38 and 31% of cases, respectively. BMD in the LI-IV and FN was significantly lower in the women with SSD than in the control examnees, regardless of age. There was a direct correlation between BMD and body mass index (BMI) and an inverse correlation between BMD and the duration of menopause, that of the disease, and cumulative dose of glucocorticoids (GCs). Among the analyzed clinical factors, there was an inverse correlation between Li-ivBMD and erythrocyte sedimentation rate (ESR), between BMD in both femoral areas (FN and PF) and C-reactive protein (CRP). The mean concentration of 25(OH)D was 19.83+11.06 ng/mL in the patients with SSD and 23.29+8.61 ng/mL in the controls; normal vitamin D levels were detected in 9% of the patients with SSD and 24% of the controls (p<0.05). Conclusion. Low BMD was found in 69% of patients with SSD, including in those with OP (38%). Most (91%) patients had vitamin D deficiency. BMD correlated with traditional risk factors: positively with BMI and negatively with age and menopause duration. The clinical factors were found to be association with disease duration and cumulative GC dose.