Background/Purpose: Primary Sjögren syndrome (pSjS) is an autoimmune disease involved multiple organs, including exocrine glands, lungs, and bone marrow. Patients with pSjS are vulnerable to fatigue and pain over extremities with deterioration of life quality. However, the risks of osteoporotic fracture remain unclear. We performed this cohort study In order to evaluate the incidence rate (IR) and risk factors of osteoporotic fractures in patients with pSjS.

Methods: A cohort study was performed by using the Taiwan National Health Insurance database. pSjS was classified as a catastrophic illnesses after verifying by a review committee. Patients with pSjS with catastrophic validation after 1997 were enrolled. Patients with other autoimmune diseases (systemic lupus erythematous, rheumatoid arthritis, etc.) or operation of fracture before enrollment, were excluded from analysis. Age and gender-matched controls without pSjS were selected as control group. The primary endpoint was the first time of osteoporotic fracture. Other risks factors, including comorbidities and medications history, were examined by using Cox proportional model.

Results: Total 3367 pSjS patients (mean 53.23 years, female 85.5%) and 22182 age, gender matched patients without pSjS were evaluated. The median follow-up time was 9.76 years. Among pSjS group, 243 patients had vertebral fractures (IR 71.18 per 1,000 person-years), 84 patients had hip fractures (IR 24.15 per 1,000 person-years), and 40 patients had radius fractures (IR 11.46 per 1,000 person-years). The incidence rate ratios of vertebral fractures (1.54, 95% CI 1.30-2.39, p<0.001) and hip fractures (1.41, 95% CI 1.10-1.79, p=0.005) revealed significant differences, but not of radius fractures (1.13, 95% CI 0.79-1.58, p=0.463). pSjS patients experienced fractures at older ages compared with control group (p<0.001). Multivariable Cox regression analyses revealed that older age, female, end-stage renal disease, and using higher doses of corticosteroid (>7.5mg per day) were associated with increasing risks of developing fractures.

Conclusion: pSjS patients had higher IR of vertebral and hip fractures, but not of radius fractures. Patients who were older, female, in end stage renal disease, or using higher doses of corticosteroid, were of elevating risks in developing fractures.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/increased-risk-of-osteoporotic-fractures-in-patients-with-primary-sjogren-syndrome-a-nationwide-population-based-study-in-taiwan/