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Association of Systemic Lupus Erythematosus With a Higher Risk of Cervical but Not Trochanteric Hip Fracture: A Nationwide Population‐Based Study
Author(s) -
Wang ShuHung,
Chang YuSheng,
Liu ChiaJen,
Lai ChienChih,
Chen WeiSheng,
Chen TzengJi,
Wang ShuuJiun
Publication year - 2013
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.22028
Subject(s) - medicine , incidence (geometry) , systemic lupus erythematosus , proportional hazards model , population , confidence interval , lupus erythematosus , cohort , hip fracture , cohort study , surgery , osteoporosis , immunology , disease , physics , environmental health , antibody , optics
Objective To determine the incidence rates and risk factors of cervical and trochanteric hip fractures (HFs) among patients with systemic lupus erythematosus (SLE) based on a nationwide population‐based data set. Methods We conducted a cohort study using data from the Taiwan National Health Insurance database. Patients with SLE and their age‐ and sex‐matched counterparts without SLE were identified. The primary end point was the first occurrence of HF. Cox proportional hazards model was used to evaluate the respective risk factors of cervical and trochanteric HFs in the lupus cohort. Results Among 14,544 patients with SLE (90% women, mean age 38.1 years) with a mean followup of 6 years, 75 developed HF (incidence rate 8.60 per 10,000 person‐years). Compared to controls, the incidence rate ratios (IRRs) for developing HF among lupus patients were 3.17 (95% confidence interval [95% CI] 1.92–5.39, P < 0.001) for cervical HF and 1.11 (95% CI 0.58–2.11, P = 0.571) for trochanteric HF. The IRRs for HF were 2.38 (95% CI 1.58–3.63, P < 0.001) for women and 1.06 (95% CI 0.21–4.93, P = 0.922) for men. Lupus patients with cervical HF were younger than controls with cervical HF (mean age 56.7 versus 67.8 years; P = 0.007). Multivariable Cox regression analyses showed that age, use of intravenous cyclophosphamide, higher dose of steroid, and stroke were associated with cervical HF, whereas age was the only associated factor for trochanteric HF. Conclusion SLE is associated with a higher risk for cervical but not trochanteric HF, and these 2 types of HFs have different risk factors.