Rheumatology International

, Volume 32, Issue 6, pp 1549–1553 | Cite as

High frequency of osteoporosis and fractures in women with dermatomyositis/polymyositis

  • Danieli Castro Oliveira de Andrade
  • Sonia Cristina de Magalhães Souza
  • Jozélio Freire de Carvalho
  • Liliam Takayama
  • Claudia Teresa Lobato Borges
  • José Mendes Aldrighi
  • Rosa Maria Rodrigues PereiraEmail author
Original Article


Bone mass was only previously studied in juvenile dermatomyositis/polymyositis (DM/PM) patients. Therefore, the objective this study was to evaluate the prevalence of osteoporosis and fractures in adult DM/PM. Forty female DM/PM and 78 age-, gender-, and BMI-matched healthy controls were studied. Medical charts and clinical interviews of all patients were evaluated for demographic and clinical data, including disease activity, cumulative doses of glucocorticoid, menarche and menopause age, and fractures. Bone mineral density (BMD) using dual X-ray absorptiometry (DXA) were measured at lumbar spine (L1–L4) and hip. A decreased BMD in lumbar spine [0.902 (0.136) vs. 0.965 (0.141) g/cm2, P = 0.022] and femoral neck [0.729 (0.12) vs. 0.784 (0.127) g/cm2, P = 0.027] was observed in patients compared to controls. In addition, osteoporosis was more frequent in patients than in controls in both lumbar spine (20 vs. 3.8%, P = 0.007) and the femoral neck (27.5 vs. 10.3%, P = 0.016). Moreover, a high prevalence of fractures was found in patients in comparison to healthy subjects (17.9 vs. 5.1%, P = 0.040; OR = 3.92; CI 95%:1.07–14.33). Comparing DM/PM patients with (n = 17) and without (n = 23) osteoporosis/fractures, significant differences were observed regarding age [56.8 (11.9) vs. 48.3 (13.2) years, P = 0.042], weight [62.05 (13.56) vs. 71.51 (11.46) kg, P = 0.022] and frequency of post menopausal women (94.1 vs. 65.2%, P = 0.0002). No differences were observed concerning height, lean mass, total fat mass, disease activity, mean value of creatine kinase, cumulative glucocorticoid dose, or bisphosphonate use. Logistic regression analysis revealed a negative association between the presence of osteoporosis/fractures and weight (OR: 0.92, 95% CI: 0.85–0.98; P = 0.016). This is the first study that analyzed bone mass in adult DM/PM patients and it demonstrated that about one quarter of these patients have osteoporosis/fracture.


Idiopathic myositis Osteoporosis Fractures Bone mineral density Weight 



We are grateful to Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPQ) # 300559/2009-7 (to RMRP) and #300665/2009-1 (to JFC), Wilhelm Agricola Federico Foundation Grant (to RMRP and JFC).


  1. 1.
    Yeap S, Fauzi A, Kong N et al (2009) Influences on bone mineral density in Malaysian premenopausal systemic lupus erythematosus patients on corticosteroids. Lupus 18:178–181PubMedCrossRefGoogle Scholar
  2. 2.
    Book C, Karlsson M, Akesson K et al (2008) Disease activity and disability but probably not glucocorticoid treatment predicts loss in bone mineral density in women with early rheumatoid arthritis. Scand J Rheumatol 37:248–254PubMedCrossRefGoogle Scholar
  3. 3.
    Souza RB, Borges CT, Takayama L et al (2006) Systemic sclerosis and bone loss: the role of the disease and body composition. Scand J Rheumatol 35:384–387PubMedCrossRefGoogle Scholar
  4. 4.
    Santiago RA, Silva CA, Caparbo VF et al (2008) Bone mineral apparent density in juvenile dermatomyositis: the role of lean body mass and glucocorticoid use. Scand J Rheumatol 37:40–47PubMedCrossRefGoogle Scholar
  5. 5.
    Michel BA, Bloch DA, Fries JF (1991) Predictors of fractures in early rheumatoid arthritis. J Rheum 18:804–808PubMedGoogle Scholar
  6. 6.
    Adinoff AD, Hollister JR (1983) Steroid-induced fractures and bone loss in patients with asthma. N Engl J Med 309:265–268PubMedCrossRefGoogle Scholar
  7. 7.
    Van Staa TP, Leufkens HGM, Cooper C (2002) The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis. Osteoporos Int 13:777–787PubMedCrossRefGoogle Scholar
  8. 8.
    Mazess RB, Whedon GD (1983) Immobilization and bone (editorial). Calcif Tissue Int 35:265–267PubMedCrossRefGoogle Scholar
  9. 9.
    Wortmann RL (2001) Inflammatory and metabolic disease of muscle. In: Klipple JH, Crofford LJ, Stone JH, Weyand CM (ed) Primer on the rheumatic disease. Arthritis Foundation, Atlanta pp 369–376Google Scholar
  10. 10.
    Clarke AE, Bloch DA, Medsger TA Jr et al (1995) A longitudinal study of functional disability in a national cohort of patients with polymyositis/dermatomyositis. Arthritis Rheum 38:1218–1224PubMedCrossRefGoogle Scholar
  11. 11.
    Stewart WA, Acott PD, Salisbury SR et al (2003) Bone mineral density in juvenile dermatomyositis. Arthritis Rheum 48:2294–2298PubMedCrossRefGoogle Scholar
  12. 12.
    Alsufyani KA, Ortiz-Alvarez O, Cabral DA et al (2005) Bone mineral density in children and adolescents with systemic lupus erythematosus, juvenile dermatomyositis and systemic vasculitis: relationship to disease duration, cumulative corticosteroid dose, calcium intake and exercise. J Rheumatol 32:729–733PubMedGoogle Scholar
  13. 13.
    Castro TC, Terreri MT, Szejnfeld VL et al (2005) Bone mineral density of Brazilian girls with juvenile dermatomyositis. Braz J Med Biol Res 38:309–313PubMedCrossRefGoogle Scholar
  14. 14.
    Bohan A, Peter JB (1975) Polymyositis and dermatomyositis (first of two parts). N Eng J Med 292:344–347CrossRefGoogle Scholar
  15. 15.
    Ponyi A, Borgulya G, Constantin T et al (2005) Functional outcome and quality of life in adlt patients with idiopathic inflammatory myositis. Rheumatology 44:83–88PubMedCrossRefGoogle Scholar
  16. 16.
    Lewiecki EM, Baim S, Binkley N et al (2008) Report of the international society for clinical densitometry 2007 adult position development conference and official positions. South Med J 101:735–739PubMedCrossRefGoogle Scholar
  17. 17.
    van Geel TA, van den Bergh JP, Dinant GJ et al (2010) Individualizing fracture risk prediction. Maturitas 65:143–814PubMedCrossRefGoogle Scholar
  18. 18.
    Kanis A, Oden A, Johansson H et al (2009) FRAX(R) and its applications to clinical practice. Bone 44:734–743PubMedCrossRefGoogle Scholar
  19. 19.
    Morin S, Tsang JF, Leslie WD (2009) Weight and body mass index predict bone mineral density and fractures in women aged 40 to 59 years. Osteoporos Int 20:363–370PubMedCrossRefGoogle Scholar
  20. 20.
    Almehed K, Forsblad d’Elia H, Kvist G, Ohlsson C, Carlsten H (2007) Prevalence and risk factors of osteoporosis in female SLE patients-extended report. Rheumatology (Oxford) 46:1185–1190CrossRefGoogle Scholar
  21. 21.
    El Maghraoui A, Rezqi A, Mounach A, Achemlal L, Bezza A, Ghozlani I (2010) Prevalence and risk factors of vertebral fractures in women with rheumatoid arthritis using vertebral fracture assessment. Rheumatology (Oxford) 49:1303–1310CrossRefGoogle Scholar
  22. 22.
    Gan WQ, Man SF, Senthilselvan A, Sin DD (2004) Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and a meta-analysis. Thorax 59:574–580PubMedCrossRefGoogle Scholar
  23. 23.
    Clarke BL, Khosla S (2010) Female reproductive system and bone. Arch Biochem Biophys 503:118–128PubMedCrossRefGoogle Scholar
  24. 24.
    Tau C, Russo R (2007) Severe osteoporosis with vertebral crushes in juvenile dermatomyositis. Effect of oral alendronate therapy. Medicina (B Aires) 67:53–56Google Scholar
  25. 25.
    Mok CC, Cheung MY, Ho LY et al (2008) Risk and predictors of work disability in Chinese patients with systemic lupus erythematosus. Lupus 17:1103–1107PubMedCrossRefGoogle Scholar
  26. 26.
    Yee CS, Crabtree N, Skan J et al (2005) Prevalence and predictors of fragility fractures in systemic lupus erythematosus. Ann Rheum Dis 64:111–113PubMedCrossRefGoogle Scholar
  27. 27.
    Li EK, Tam LS, Griffith JF et al (2009) High prevalence of asymptomatic vertebral fractures in Chinese women with systemic lupus erythematosus. J Rheumatol 36:1646–1652PubMedCrossRefGoogle Scholar
  28. 28.
    Mendoza-Pinto C, García-Carrasco M, Sandoval-Cruz H et al (2009) Risk factors of vertebral fractures in women with systemic lupus erythematosus. Clin Rheumatol 28:579–585PubMedCrossRefGoogle Scholar
  29. 29.
    Borba VZ, Matos PG, da Silva Viana PR et al (2005) High prevalence of vertebral deformity in premenopausal systemic lupus erythematosus patients. Lupus 14:529–533PubMedCrossRefGoogle Scholar
  30. 30.
    Ørstavik RE, Haugeberg G, Uhlig T et al (2004) Self reported non-vertebral fractures in rheumatoid arthritis and population based controls: incidence and relationship with bone mineral density and clinical variables. Ann Rheum Dis 63:177–182PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Danieli Castro Oliveira de Andrade
    • 1
  • Sonia Cristina de Magalhães Souza
    • 1
  • Jozélio Freire de Carvalho
    • 1
  • Liliam Takayama
    • 1
  • Claudia Teresa Lobato Borges
    • 1
  • José Mendes Aldrighi
    • 2
  • Rosa Maria Rodrigues Pereira
    • 1
    Email author
  1. 1.Division of RheumatologyFaculdade de Medicina da Universidade de São PauloSão PauloBrazil
  2. 2.Faculdade de Saúde Pública da Universidade de São PauloSão PauloBrazil

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