Disability score predicts fracture risk in systemic sclerosis
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Key takeaways:
- Higher disability scores indicate a higher likelihood of fracture in patients with systemic sclerosis.
- Identifying modifiable risk factors for fracture could improve quality of life in patients with systemic sclerosis.
Higher disability scores are a potential predictor of fracture risk among patients with systemic sclerosis, according to data published in Arthritis Care & Research.
“While a study of patients from France found that SSc is associated with an increased risk of osteoporosis and fracture compared with the general population, the risk of fracture in patients with SSc in the U.S., and the relative impact that specific SSc-related comorbidities and other clinical features may have in these patients remains unclear,” Bliss Rogers, DO, of John Hopkins University, and colleagues wrote. “Furthermore, the identification of modifiable risk factors for fracture could improve patient quality of life, while secondarily addressing the economic burden associated with osteoporotic fractures.”
To investigate potential factors associated with fracture risk in patients with SSc, Rogers and colleagues conducted an analysis of the FORWARD database, a national data bank of patients with rheumatic diseases. Patients in the registry with SSc, as well as age- and gender-matched patients with osteoarthritis, as a comparator group, were included in the analysis at a ratio of 1:5. Those with both SSc and OA were excluded from the analysis.
Patients registered in the database reported certain variables upon enrollment as well as on a subsequent, semiannual basis. Regularly reported data included age, disease duration, status of menopause, education, BMI and smoking status. Sex and race were reported upon enrollment. Patients additionally reported details regarding their medical histories. Medications were reported on enrollment and at semiannual questionnaires.
The researchers used several fracture and disease severity assessments, such as the Fracture Risk Assessment Tool (FRAX), the Health Assessment Questionnaire-Disability Index (HAQ-DI) and the Rheumatic Disease Comorbidity Index (RDCI). The primary outcome was the occurrence of a major osteoporotic fracture. Fractures in skulls, hands, feet, fingers and toes were not considered.
The analysis included a total of 922 patients, of whom 154 had SSc and 768 had OA. In all, 51 patients experienced at least one fracture during a median of 4.2 years of follow-up. In general, patients with SSc were more likely than patients with OA to experience a fracture (HR = 2.38; 95% CI 1.47-3.83), according to the researchers. Among patients with SSc, the factors associated with more fractures included a higher rheumatic disease comorbidity index (HR = 1.45; 95% CI, 1.2-1.75) and a higher score on the HAQ-DI (HR = 3.83; 95% CI, 2.12-6.93).
“We observed a higher fracture rate in patients with SSc relative to OA comparators,” Rogers and colleagues wrote. “We found that comorbidity burden and higher physical disability were strongly associated with a high fracture rate in both scleroderma and OA.”
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