Treatment of systemic lupus erythematosus (SLE) often continues with moderate-to-low doses of glucocorticoids for the long term. Bisphosphonates aid in the prevention and management of glucocorticoid-induced osteoporosis (GIOP). However, long-term use of bisphosphonates increases the relative risk of atypical femoral fracture (AFF) and the incidence is typically 16 or 113 per 100,000 person-years in patients treated with bisphosphonates for 5 or 10 years, respectively. Here, we explored bisphosphonate prescription rate and prevalence of AFF in patients with SLE. In total, 270 patients with SLE were enrolled. The Japanese Society for Bone and Mineral Research Guideline 2014 for GIOP management and treatment was used. We also explored AFF history through medical records. Most (n = 251) patients were recommended to treat by the GIOP guideline (scores ≥ 3); bisphosphonates, denosumab, teriparatide, or active vitamin D was prescribed for 85.7%. Bisphosphonates were currently used by 66.1% of the patients, and 65% had used them for ≥ 5 years. Of all patients, 76.7% had a history of bisphosphonate use, 5 of 270 (1.9%) had histories of AFF. Four of five patients with AFF had taken bisphosphonates for ≥ 3.5 years, in addition to moderate doses (≥ 10 mg/day) of glucocorticoids. For the SLE patients with a history of bisphosphonate use, the incidence of AFF was calculated to be 278 per 100,000 person-years. Our single-center study found that bisphosphonates were commonly used long term by Japanese patients with SLE. As AFF is not rare, AFF should be cared in patients with SLE.
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HS, NK, AW, DK, TN, and YW collected and analyzed the data. HS wrote the initial draft of the manuscript. NK, TK, YS, MN, EN, and IN assisted in the interpretation of the data and preparation of the manuscript. All of the authors have critically reviewed the manuscript and approved the final version of the manuscript.
Compliance with ethical standards
Conflicts of interest
All authors have no conflicts of interest.
Suzuki Y, Nawata H, Soen S, Fujiwara S, Nakayama H et al (2014) Guidelines on the management and treatment of glucocorticoid-induced osteoporosis of the Japanese Society for Bone and Mineral Research: 2014 update. J Bone Miner Metab 32:337–350CrossRefGoogle Scholar
Buckley L, Guyatt G, Fink HA, Cannon M, Grossman J et al (2017) 2017 American college of rheumatology guideline for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Rheumatol 69:1521–1537CrossRefGoogle Scholar
Briot K, Cortet B, Roux C, Fardet L, Abitbol V et al (2014) 2014 update of recommendations on the prevention and treatment of glucocorticoid-induced osteoporosis. Joint Bone Spine 81:493–501CrossRefGoogle Scholar
Compston J, Bowring C, Cooper A, Cooper C, Davies C et al (2013) Diagnosis and management of osteoporosis in postmenopausal women and older men in the UK: National Osteoporosis Guideline Group (NOGG) update 2013. Maturitas 75:392–396CrossRefGoogle Scholar
Compston J, Cooper A, Cooper C, Gittoes N, Gregson C et al (2017) UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos 12:43CrossRefGoogle Scholar
Trijau S, de Lamotte G, Pradel V, Natali F, Allaria-Lapierre V et al (2016) Osteoporosis prevention among chronic glucocorticoid users: results from a public health insurance database. RMD Open 2:e000249CrossRefGoogle Scholar
Feldstein AC, Elmer PJ, Nichols GA, Herson M (2005) Practice patterns in patients at risk for glucocorticoid-induced osteoporosis. Osteoporos Int 16:2168–2174CrossRefGoogle Scholar
Duyvendak M, Naunton M, Atthobari J, van den Berg PB, Brouwers JR (2007) Corticosteroid-induced osteoporosis prevention: longitudinal practice patterns in The Netherlands 2001–2005. Osteoporos Int 18:1429–1433CrossRefGoogle Scholar
Klop C, de Vries F, Vinks T, Kooij MJ, van Staa TP et al (2014) Increase in prophylaxis of glucocorticoid-induced osteoporosis by pharmacist feedback: a randomised controlled trial. Osteoporos Int 25:385–392CrossRefGoogle Scholar
Overman RA, Toliver JC, Yeh JY, Gourlay ML, Deal CL (2014) United States adults meeting 2010 American College of Rheumatology criteria for treatment and prevention of glucocorticoid-induced osteoporosis. Arthritis Care Res (Hoboken) 66:1644–1652CrossRefGoogle Scholar
Adler RA, El-Hajj Fuleihan G, Bauer DC, Camacho PM, Clarke BL et al (2016) Managing osteoporosis in patients on long-term bisphosphonate treatment: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 31:1910CrossRefGoogle Scholar
Saita Y, Ishijima M, Mogami A, Kubota M, Baba T et al (2015) The incidence of and risk factors for developing atypical femoral fractures in Japan. J Bone Miner Metab 33:311–318CrossRefGoogle Scholar
Sato H, Kondo N, Wada Y, Nakatsue T, Iguchi S et al (2016) The cumulative incidence of and risk factors for latent beaking in patients with autoimmune diseases taking long-term glucocorticoids and bisphosphonates. Osteoporos Int 27:1217–1225CrossRefGoogle Scholar
Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40:1725CrossRefGoogle Scholar
Shane E, Burr D, Abrahamsen B, Adler RA, Brown TD et al (2014) Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 29:1–23CrossRefGoogle Scholar
Odvina CV, Zerwekh JE, Rao DS, Maalouf N, Gottschalk FA et al (2005) Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab 90:1294–1301CrossRefGoogle Scholar
Kondo N, Fukuhara T, Watanabe Y, Miyasaka D, Yamamoto N et al (2017) Bone formation parameters of the biopsied Ilium differ between subtrochanteric and diaphyseal atypical femoral fractures in bisphosphonate-treated patients. Tohoku J Exp Med 243:247–254CrossRefGoogle Scholar
Kondo N, Yoda T, Fujisawa J, Arai K, Sakuma M et al (2015) Bilateral atypical femoral subtrochanteric fractures in a premenopausal patient receiving prolonged bisphosphonate therapy: evidence of severely suppressed bone turnover. Clin Cases Miner Bone Metab 12:273–277Google Scholar
Girgis CM, Sher D, Seibel MJ (2010) Atypical femoral fractures and bisphosphonate use. N Engl J Med 362:1848–1849CrossRefGoogle Scholar
Sato H, Kondo N, Nakatsue T, Wada Y, Fujisawa J et al (2017) High and pointed type of femoral localized reaction frequently extends to complete and incomplete atypical femoral fracture in patients with autoimmune diseases on long-term glucocorticoids and bisphosphonates. Osteoporos Int 28:2367–2376CrossRefGoogle Scholar
Cummings SR, Cosman F, Lewiecki EM, Schousboe JT, Bauer DC et al (2017) Goal-directed treatment for osteoporosis: a progress report from the ASBMR-NOF working group on goal-directed treatment for osteoporosis. J Bone Miner Res 32:3–10CrossRefGoogle Scholar