Abstract
In this case–control study, our first aim was to evaluate the bone mineral density (BMD) in women with systemic sclerosis (SSc) and its correlates. Secondarily, we aimed to evaluate 25-hydroxyvitamin D3 status and its relationships with disease parameters and BMD. Sixty patients with SSc and 60 age—and gender-matched controls were included in the absence of confounding factors that interfere with bone metabolism. Body mass index, menopausal status, familial history of osteoporosis and/or fractures; personal fracture history; exercise activity and laboratory parameters of bone metabolism were assessed in patients and controls. BMD was measured by using a dual-energy X-ray absorptiometry in lumbar spine (L1–L4) and femoral neck. The 25-hydroxyvitamin D3 was measured in a subgroup of 30 patients and in a subgroup of 30 matched controls. Systemic manifestations of SSc, biological inflammatory parameters, functional disability (scleroderma health assessment questionnaire (S-HAQ)) and immunological status of disease were collected in patients’ group. The mean age of patients was 49.44 ± 13.07 years versus 49.55 ± 12.11 in controls. The mean disease duration was 9.63 ± 5.9 years. SSc patients had a significantly earlier age and longer duration of menopause than controls (P = 0.003). Phosphocalcic metabolism parameters were within normal ranges in both groups. BMD was significantly lower in SSc patients than in controls both in lumbar spine (−2.97 ± 0.25 in patients vs. 0.46 ± 0.11 in controls) and femoral neck (−1.93 ± 0.32 in patients vs. −0.81 ± 0.69 in controls) (P < 0.01). Thirty-six (60%) patients versus 15 (25%) controls had osteoporosis and 19 (31.7%) patients versus 13 (21.7%) controls had osteopenia (P < 0.01). In correlation analysis and in multiple regression models, there were significant correlations between BMD and longer duration of SSc, severe joint involvement (severe joint pain and erosive arthropathy), malabsorption syndrome and the positivity of anti-DNA topoisomerase I antibodies. Also, we found very low levels of vitamin D (10.88 ± 2.68 ng/ml) comparing to controls (57.41 ± 4.18 ng/ml) (P = 0.001). Vitamin D levels were correlated with the severity of joint pain, with immunological status and with BMD in lumbar spine and femoral neck (P < 0.01). In our sample, we state the importance of decreased BMD in Moroccan women with SSc with a high frequency of osteoporosis comparing to healthy controls. Bone loss seems to be associated with prolonged disease duration, severe joint involvement, malabsorption syndrome and immunological status. Also, SSc patients had lower levels of 25-hydroxyvitamin D3 than controls. Larger studies are needed to confirm those findings.
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Suarez-Almazor ME, Kallen MA, Roundtree AK, Mayes M (2007) Disease and symptom burden in systemic sclerosis: a patient perspective. J Rheumatol 34:1718–1726
Allali F, Tahiri L, Senjari A, Abouqal R, Hajjaj-Hassouni N (2007) Erosive arthropathy in systemic sclerosis. BMC Public Health 7:260
Loucks J, Pope JE (2005) Osteoporosis in scleroderma. Semin Arthritis Rheum 34(4):678–682
Souza RB, Borges CT, Takayama L, Aldrighi JM, Pereira RM (2006) Systemic sclerosis and bone loss: the role of the disease and body composition. Scand J Rheumatol 35(5):384–387
Frediani B, Baldi F, Falsetti P, Acciai C, Filippou G, Spreafico A, Siagri C, Chellini F, Capperucci C, Filipponi P, Galeazzi M, Marcolongo R (2004) Clinical determinants of bone mass and bone ultrasonometry in patients with systemic sclerosis. Clin Exp Rheumatol 22(3):313–318
Pelajo CF, Lopez-Benitez JM, Miller LC (2010) Vitamin D and autoimmune rheumatologic disorders. Autoimmun Rev 9(7):507–510
Deluca HF, Cantorna MT (2001) Vitamin D: its role and uses in immunology. FASEB J 15(14):2579–2585
Cutillas-Marco E, Morales-Suárez-Varela M, Marquina-Vila A, Grant W (2010) Serum 25-hydroxyvitamin D levels in patients with cutaneous lupus erythematosus in a Mediterranean region. Lupus 19(7):810–814
Alexandersson BT, Geirsson AJ, Olafsson I, Franzson L, Sigurdsson G, Gudbjornsson B (2007) Bone mineral density and bone turnover in systemic sclerosis. Laeknabladid 93(7–8):535–541
Braun-Moscovici Y, Furst DE, Markovits D, Rozin A, Clements PJ, Nahir AM, Balbir-Gurman A (2008) Vitamin D, parathyroid hormone, and acroosteolysis in systemic sclerosis. J Rheumatol 35(11):2201–2205
Masi AT and the subcommittee for scleroderma criteria of the American Rheumatism Association diagnostic and therapeutic criteria committee. Preliminary criteria for the classification of systemic sclerosis (scleroderma). Arthritis Rheum 1980; 23: 581–90
LeRoy EC, Medsger TA Jr (2001) Criteria for the classification of early systemic sclerosis. J Rheumatol 28:1573–1576
Georges C, Chassany C, Mouthon L, Tiev K, Toledano C, Meyer O et al (2005) Validation of French version of the scleroderma Health Assessment Questionnaire (SSc HAQ). Clin Rheumatol 24:3–10
Di Munno O, Mazzantini M, Massei P, Ferdeghini M, Petaro N, Latorraca A et al (1995) Reduced bone mass and normal calcium metabolism in systemic sclerosis with and without calcinosis. Clin Rheumatol 14:407–412
Sampaio-Barros PD, Costa-Paiva L, Filardi S, Sachetto Z, Samara AM, Marques-Neto JF (2005) Prognostic factors of low bone mineral density in systemic sclerosis. Clin Exp Rheumatol 23(2):180–184
Da Silva HC, Szejnfeld VL, Assis LS, Sato EI (1997) Study of bone density in systemic scleroderma. Rev Assoc Med Bras 43(1):40–46
La Montagna G, Vatti M, Valentini G, Tirri G (1991) Osteopenia in systemic sclerosis. Evidence of a participating role of earlier menopause. Clin Rheumatol 10(1):18–22
Carbone L, Tylavsky F, Wan J, McKown K, Cheng S (1999) Bone mineral density in scleroderma. Rheumatol (Oxford) 371–372
Yuen SY, Rochwerg B, Ouimet J, Pope JE (2008) Patients with scleroderma may have increased risk of osteoporosis. A comparison to rheumatoid arthritis and noninflammatory musculoskeletal conditions. J Rheumatol 35(6):1073–1078
La Montagna G, Baruffo A, Pasquali D, Bellastella A, Tirri G, Sinisi AA (2001) Assessment of pituitary gonadotropin release to gonadotropin releasing hormone/thyroid-stimulating hormone stimulation in women with systemic sclerosis. Rheumatol 40(3):310–314
Dovio A, Data V, Carignola R, Calzolari G, Vitetta R, Ventura M, Saba L, Severino A, Angeli A (2008) Circulating osteoprotegerin and soluble RANK ligand in systemic sclerosis. J Rheumatol 35(11):2206–2213
Lewiecki EM (2006) RANK ligand inhibition with denosumab for the management of osteoporosis. Expert Opin Biol Ther 6(10):1041–1050
Kim J, Park SK, Moon KW, Lee EY, Lee YJ, Song YW, Lee EB (2010) The prognostic factors of systemic sclerosis for survival among Koreans. Clin Rheumatol 29(3):297–302
Caramaschi P, Dalla Gassa A, Ruzzenente O, Volpe A, Ravagnani V, Tinazzi I, Barausse G, Bambara LM, Biasi D (2010) Very low levels of vitamin D in systemic sclerosis patients. Clin Rheumatol [Epub ahead of print]
Allali F, El Aichaoui S, Khazani H, Benyahia B, Saoud B, El Kabbaj S, Bahiri R, Abouqal R, Hajjaj-Hassouni N (2009) High prevalence of hypovitaminosis D in Morocco: relationship to lifestyle, physical performance, bone markers, and bone mineral density. Semin Arthritis Rheum 38(6):444–451
Belloli L, Ughi N, Marasini B (2010) Vitamin D in systemic sclerosis. Clin Rheumatol
Vacca A, Cormier C, Piras M, Mathieu A, Kahan A, Allanore Y (2009) Vitamin D deficiency and insufficiency in 2 independent cohorts of patients with systemic sclerosis. J Rheumatol 36(9):1924–1929
Adorini L, Penna G (2008) Control of autoimmune diseases by the vitamin D endocrine system. Nat Clin Pract Rheumatol 4(8):404–412
Van Etten E, Gysemans C, Branisteanu DD, Verstuyf A, Bouillon R, Overbergh L, Mathieu C (2007) Novel insights in the immune function of the vitamin D system: synergism with interferon-beta. J Steroid Biochem Mol Biol 103(3–5):546–551
Hulshof MM, Pavel S, Breedveld FC, Dijkmans BA, Vermeer BJ (1994) Oral calcitriol as a new therapeutic modality for generalized morphea. Arch Dermatol 130(10):1290–1293
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Ibn Yacoub, Y., Amine, B., Laatiris, A. et al. Bone density in Moroccan women with systemic scleroderma and its relationships with disease-related parameters and vitamin D status. Rheumatol Int 32, 3143–3148 (2012). https://doi.org/10.1007/s00296-011-2150-1
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DOI: https://doi.org/10.1007/s00296-011-2150-1