Women With Lupus Seem at Higher Risk for Hip Fractures07/04/13
THURSDAY, July 4 (HealthDay News) -- Women with lupus -- the
autoimmune disease that can damage skin, joints and organs -- also
are at higher risk of a hip fracture known as a cervical fracture,
new research from Taiwan suggests.
Dr. Shu-Hung Wang, of the Taipei Veterans General Hospital, and
his colleagues evaluated nearly 15,000 adults -- 90 percent of them
women -- who had lupus. They followed them for an average of six
During that time, 75 suffered a hip fracture. Of those, 57 were
cervical fractures of the hip; the other 18 were trochanteric
fractures of the hip.
"Anatomically, cervical hip fractures involve the [uppermost area of the thighbone]," said Dr. Shu-Hung Wang, a rheumatology fellow at the hospital and a co-author of the study. "Trochanteric hip fracture occurs between the lesser and greater trochanters." Trochanters are the bony prominences near the end of the thighbone.
The researchers compared the women and men with lupus to the
same number of healthy people without lupus. In the healthy group,
43 had hip fractures during the follow-up period, and they were
evenly divided between the two types.
Having lupus, the researchers concluded, raised the risk for
cervical fractures compared to the general population, but not for
the other fracture type. And women with lupus got cervical
fractures at younger ages, the researchers said.
Not enough men were included in the study to do a scientific
analysis of their fracture risk.
The study, which didn't prove that lupus leads to hip fractures,
appeared online recently in the journal
Arthritis Care & Research.
The number of people studied lends strength to the findings,
said Dr. David Pisetsky, a professor of medicine at the Duke
University School of Medicine and a member of the scientific
advisory board for the Lupus Research Institute. Pisetsky reviewed
the findings but was not involved in the study.
"When you get 15,000 [subjects], you get confidence in the numbers," he said.
The higher risk of hip fracture is not surprising, due to the
nature of the disease, he said. Lupus involves a malfunction of the
immune system. Normally, the immune system makes antibodies in
response to invaders; in lupus, the body can't differentiate
invaders from normal tissue, so it makes autoantibodies that turn
on the body, attacking normal tissue.
The autoantibodies cause inflammation, pain and damage to the
"The systemic inflammation affects bone," Pisetsky said. Patients often are prescribed steroid medicine to relieve the inflammation, but the medicines can also affect bones adversely, he said.
Although the risk to bones in lupus patients is known, the new
study teases out details on the type of fracture risk, Pisetsky
Treatments, especially the steroids, can affect the bones, said
Dr. Joan Merrill, medical director of the Lupus Foundation of
America and chairwoman of the clinical pharmacology research
program at the Oklahoma Medical Research Foundation. "Steroids are
also associated with increased risk for osteonecrosis [death of the
bones], which literally can cause the hip joint and other joints to
collapse," she said.
For those reasons, experts in recent years have been focusing on
using the lowest dose possible of steroids to control symptoms,
To help preserve bone health, Pisetsky tells his lupus patients
to get enough calcium and vitamin D and to take bone-maintenance
drugs, if their doctor decides they are necessary.
Getting regular exercise can help too, he said. With age, lupus
patients should try to preserve their balance, which also can
reduce the risk of falls.
Study co-author Wang reported serving on advisory boards and
receiving honoraria for speaking from several pharmaceutical
companies. The study was funded by the Taiwan National Science
Council, Taipei Veterans General Hospital and other
To learn more about lupus, visit the
Lupus Foundation of America.
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