High Prevalence of Osteoporosis and Fractures Is Associated with Abdominal Adiposity and Decreased Muscular Strength in Primary Necrotizing Vasculitides

Karine Briot¹, Bertrand Dunogué², Alexis Regent³, Pascal Cohen², Alice Berezne², Sami Kolta¹, Xavier Puéchal², Claire Le Jeunne⁴, Luc Mouthon⁵, Christian Roux¹, Loïc Guillevin⁶ and Benjamin Terrier², ¹Rheumatology B Department, Hôpital Cochin, Paris, France, ²Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Paris, France, ³Service de médecine interne, Hôpital Cochin, Paris, France, ⁴Department of Internal Medicine, Hotel-Dieu Hospital, AP-HP, Paris, Paris, France, ⁵Department of Internal Medicine, Department of Internal Medicine, Cochin Hospital, Referent Center for Necrotizing Vasculitis and Systemic Sclerosis, Paris-Descartes University, AP-HP, Paris, France, ⁶Internal Medicine, Hopital Cochin, Paris, France

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Cardiovascular disease, Comorbidity, grip strength, osteoporosis and vasculitis

Session Information

Date: Sunday, November 8, 2015

Title: Osteoporosis and Metabolic Bone Disease - Clinical Aspects and Pathogenesis Poster

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose:

Overall survival of primary necrotizing vasculitides, including ANCA-associated vasculitis (AAV) and polyarteritis nodosa (PAN), has greatly improved over the last 50 years. Because of a longer survival and prolonged treatment, long-term sequelae and comorbidities have now become a major concern. Studies assessing the prevalence of osteoporosis, fractures and their determinants, in these patients are lacking. The aim of this study is to assess the prevalence of osteoporosis and fractures in patients with vasculitides and to identify variables associated with their presence.

Methods:

Patients with AAV and PAN seen in our department were prospectively included in an ongoing cross-sectional study assessing bone complications and other sequelae (OSTEOVAS cohort). Lumbar spine and hip bone mineral density (BMD), body composition (lean and fat masses) and abdominal fat masses (visceral and subcutaneous) were measured by Dual X-ray Absorptiometry (DXA). Vertebral fractures were assessed using the Vertebral Fracture Assessment (VFA) measured by DXA.

Results:

One hundred and twenty consecutive patients were analyzed (66 females and 54 males, mean age 53±18 years, with a median disease duration of 54 months). Diagnoses were granulomatosis with polyangiitis in 61 patients, eosinophilic granulomatosis with polyangiitis in 30, PAN in 14, microscopic polyangiitis in 13, and cryoglobulinemia vasculitis in 2 cases. The median daily dose of glucocorticoids was 8.5 mg/day (0-80), with an estimated total cumulative dose of 15000±10000 mg of glucocorticoids. Osteoporosis was observed in 36 patients (30%) and low trauma fractures in 33 patients (27.5%). Overall, osteoporosis and/or previous fractures were observed in 54 patients (45%). Among them, only 18 (33%) received an antiosteoporotic treatments, and 20 (37%) and 34 (63%) had calcium and vitamin D supplementation.

Variables significantly associated with bone disease in multivariate analysis were an increased visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) ratio [OR 1.03 (1.01-1.05); P=0.005], decreased calcium intakes [OR 0.998 (0.997-1.00); P=0.02] and decreased grip strength [OR 0.22 (0.08-0,60), P=0.003]. Variables significantly associated with fractures in multivariate analysis were an increased age [OR 1.05 (1.01-1.08); P=0.006], decreased calcium intakes [OR 0.998 (0.996-1.00); P=0.046] and increased Vascular Damage Index (VDI) evaluating sequelae related to vasculitis and/or treatments [OR 1.28 (1.02-1,60), P=0.03]. Finally, using multiple linear regression analysis, femoral neck BMD was independently associated with age (P=0.0003), skeletal muscle mass (P<0.0001), VDI (P=0.008), and grip strength (P=0.03).

Conclusion: Osteoporosis and fractures are observed in nearly half of patients with primary necrotizing vasculitides and only 33% received an antiosteoporotic treatment. Increase in abdominal adiposity and decrease in muscular function are strongly associated with bone complications. Bone complications assessment, cardiovascular risk and muscular function should be assessed and managed in clinical practice in patients with primary necrotizing vasculitides.

Disclosure: K. Briot, None; B. Dunogué, None; A. Regent, None; P. Cohen, None; A. Berezne, None; S. Kolta, None; X. Puéchal, None; C. Le Jeunne, None; L. Mouthon, None; C. Roux, None; L. Guillevin, None; B. Terrier, None.

To cite this abstract in AMA style:

Briot K, Dunogué B, Regent A, Cohen P, Berezne A, Kolta S, Puéchal X, Le Jeunne C, Mouthon L, Roux C, Guillevin L, Terrier B. High Prevalence of Osteoporosis and Fractures Is Associated with Abdominal Adiposity and Decreased Muscular Strength in Primary Necrotizing Vasculitides [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/high-prevalence-of-osteoporosis-and-fractures-is-associated-with-abdominal-adiposity-and-decreased-muscular-strength-in-primary-necrotizing-vasculitides/. Accessed .

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