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Recurrent fractures in an elderly patient with systemic lupus erythematosus
Author(s) -
CHIA Faith LiAnn,
THONG Bernard YuHor,
LAU TangChing,
FENG PaoHsii
Publication year - 2009
Publication title -
international journal of rheumatic diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.795
H-Index - 41
eISSN - 1756-185X
pISSN - 1756-1841
DOI - 10.1111/j.1756-185x.2009.01422.x
Subject(s) - medicine , frax , teriparatide , osteoporosis , systemic lupus erythematosus , bisphosphonate , vitamin d and neurology , bone mineral , lupus erythematosus , disease , physical therapy , pediatrics , intensive care medicine , osteoporotic fracture , immunology , antibody
Abstract Glucocorticoid‐induced osteoporosis (GIO) is an important problem that remains undertreated, even by rheumatologists. We present a case of an elderly patient with systemic lupus erythematosus diagnosed more than 40 years ago, who suffered from recurrent fractures and attendant complications despite a bone mineral density (BMD) score in the osteopenic range and treatment with bisphosphonates. With improved treatment and outcome of lupus, an increasing number of elderly patients who are susceptible to osteoporotic fractures are expected. This case serves to highlight that rheumatic disease patients on steroids should be screened for GIO, as effective treatment and preventive measures are available. Teriparatide is a promising treatment for patients who have failed bisphosphonate treatment or who are at high risk for fracture. We should also bear in mind that BMD scores alone are not indicative of fracture risk, and other tools such as the WHO‐FRAX (Fracture risk assessment tool), serum vitamin D3 levels and bone turnover markers should be used where appropriate. Other measures including attention to factors that contribute to falls should also be considered, necessitating a multi‐disciplinary approach.