Patients with systemic sclerosis have a high risk of bone fractures

Patients with systemic sclerosis may be more likely to develop osteoporosis and experience bone fractures.


Systemic sclerosis is a serious disease of the connective tissues, where the tissue grows abnormally and triggers the immune system to attack itself (autoimmunity). This can cause hardening (fibrosis) and swelling of the skin, as well as joint pain, digestive problems and lung disease caused by fibrosis and scarring. It usually starts in people aged 30–50 years of age, and is slightly more common in women than men.
Osteoporosis is a skeletal disease causes by reduced bone mineral density, causing bones to become fragile and more likely to fracture. Patients with autoimmune diseases such as systemic sclerosis may have an increased risk of developing osteoporosis.


The authors aimed to investigate the rate and risk factors involved in the development of osteoporotic fractures – including hip, wrist, forearm and spinal fractures – among patients with systemic sclerosis.


The study included 1712 Taiwanese patients with systemic sclerosis defined according to the 1980 American College of Rheumatology (ACR) classification criteria. All patients were over the age of 18, and there were more women than men. In order to draw comparisons and conclusions, the study also looked at 10,272 ageand gender-matched control patients without systemic sclerosis.


This was a nationwide observational cohort study performed in the Taiwan National Health Insurance database, which collates medical data for all admitted patients and outpatients in the country. This means that the authors collected data on a set of patients, but made no interventions and there was no medicine under investigation. The control group was identified randomly from the database. Patients were excluded if they had previously had osteoporotic or pathologic fractures (those caused by a disease rather than trauma or injury), or a history of malignancies or cancers.


Patients with systemic sclerosis were almost twice as likely to develop osteoporotic fractures of the vertebrae (spine) and hips compared to patients without systemic sclerosis. The patients with systemic sclerosis suffered from hip fractures earlier than the controls, on average at 67 years of age compared to 75 years. Patients with systemic sclerosis who experienced a vertebral fracture were less likely to survive, with 13% of them dying within 1 year of the fracture, compared to only 3% in patients without systemic sclerosis. Overall, the authors found that osteoporotic fractures were more common in female patients, those with older age, patients using a high dose of steroid treatment (more than 7.5 mg of prednisolone every day), and patients with bowel problems.


The authors believe that this is the first cohort study focusing on the risk of osteoporotic fractures in patients with systemic sclerosis.


There are some limitations in the data that was collected in the database. For example, information regarding different subtypes of systemic sclerosis, severity of skin tightening, bone mineral density, body mass index, menopausal status, autoantibody profiles, and radiographic findings were not available. It was also not known whether there was a family history of osteoporotic fractures, or what the patients’ smoking and nutrition statuses were, which may have a bearing on the development of osteoporosis. Additionally, the diagnosis of systemic sclerosis was not based on the most up to date 2013 criteria, but on an older system. Finally, the ethnic background of patients in the study was predominantly Asian, which may limit how useful the results are in other patient groups.


The authors are interested in investigating the role that bowel involvement and steroid use may play in the development of osteoporotic fracture in patients with systemic sclerosis. More studies are planned to look at the development and treatment of osteoporotic fractures in these patients.


The rate of osteoporotic fractures is significantly higher in people with systemic sclerosis than in those without. If you have systemic sclerosis you can minimise the risk of suffering from a fracture by stopping smoking and including foods such as dairy products and leafy greens which are rich in calcium in your diet. This is particularly important if you take more than 7.5 mg of steroid medicine each day. Patients with systemic sclerosis should have regular checks to ensure that they have good bone health, but if you are concerned about your risks you should talk to your doctor.

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Date summary prepared: July 2015

Summary based on research article published on: 14 February 2014

From: Lai, C. et al. Increased risk of osteoporotic fractures in patients with systemic sclerosis: a nationwide population-based study. Ann Rheum Dis 2015;74:1347–52. doi:10.1136/annrheumdis-2013-204832

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