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Rheumatology International

, Volume 39, Issue 10, pp 1803–1810 | Cite as

High bisphosphonate treatment rates and the prevalence of atypical femoral fractures in patients with systematic lupus erythematosus: a single-center retrospective study performed in Japan

  • Hiroe SatoEmail author
  • Naoki Kondo
  • Ayako Wakamatsu
  • Daisuke Kobayashi
  • Takeshi Nakatsue
  • Yoko Wada
  • Takeshi Kuroda
  • Yoshiki Suzuki
  • Masaaki Nakano
  • Naoto Endo
  • Ichiei Narita
Pharmacovigilance
  • 89 Downloads

Abstract

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.

Keywords

Systemic lupus erythematosus Glucocorticoid-induced osteoporosis Bisphosphonate Guideline Atypical femoral fracture 

Notes

Author contributions

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.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Hiroe Sato
    • 1
    • 2
    Email author
  • Naoki Kondo
    • 3
  • Ayako Wakamatsu
    • 2
  • Daisuke Kobayashi
    • 2
  • Takeshi Nakatsue
    • 2
  • Yoko Wada
    • 2
  • Takeshi Kuroda
    • 1
  • Yoshiki Suzuki
    • 1
  • Masaaki Nakano
    • 4
  • Naoto Endo
    • 3
  • Ichiei Narita
    • 2
  1. 1.Health Administration CenterNiigata UniversityNiigata CityJapan
  2. 2.Division of Clinical Nephrology and RheumatologyNiigata University Graduate School of Medical and Dental SciencesNiigata CityJapan
  3. 3.Division of Orthopedic SurgeryNiigata University Graduate School of Medical and Dental SciencesNiigata CityJapan
  4. 4.Department of Medical Technology, School of Health Sciences, Faculty of MedicineNiigata UniversityNiigata CityJapan

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