Previous research has found that patients with systemic lupus erythematosus (SLE) tend to have poor bone health. In a recent study, researchers found that SLE patients—specifically those with low-income and who have lupus nephritis (LN)—have an increased risk for fracture.
For the study, published in Arthritis & Rheumatology, researchers evaluated Medicaid enrollees between 2007 and 2010. They age- and sex-matched patients with SLE to non-SLE patients, and they identified patients who also had LN. SLE was determined based on the presence of at least three International Classification of Diseases, Ninth Revision codes for SLE, and LN patients had at least two more codes for renal disease. Researchers gathered demographic, prescription, and comorbidity data during the 180-day baseline period. The primary outcome was pelvis, wrist, hip, or humerus fracture. Analysis was also conducted for SLE patients with and without LN.
There were 47,709 patients with SLE, of whom nearly 20% (19.8%) had LN; SLE patients were matched to 190,836 non-SLE patients. Mean age was 41.4 years, and the majority of patients (92.6%) were female. Patients with SLE with LN had the highest fracture incidence rates (4.60/1,000 person‐years). Compared to matched non-SLE patients, those with SLE were twice as likely to sustain a fracture (HR 2.09 [95% CI 1.85, 2.37]), and LN patients had triple the risk (HR 3.06 [2.24, 4.17]). LN patients also had a greater risk for fracture than SLE patients without LN (HR 1.58 [1.20, 2.07]). In sensitivity analyses, the use of glucocorticoids and comorbidities only slightly impacted risk.
“Fracture risks were elevated in SLE patients, particularly those with lupus nephritis, compared to matched non‐SLE Medicaid patients. Elevated risks persisted after adjustment for baseline glucocorticoids and comorbidities,” the researchers wrote in their abstract.
Source: Arthritis & Rheumatology