Skip to main content

Advertisement

SpringerLink
Log in

Increased osteoporosis risk in dermatomyositis or polymyositis independent of the treatments: a population-based cohort study with propensity score

  • Original Article
  • Published:
Endocrine Aims and scope Submit manuscript

Abstract

We investigated the relationship between dermatomyositis/polymyositis (DM/PM) and the risk of subsequent osteoporosis development. A population-based retrospective cohort analysis was conducted using the National Health Insurance Research Database and the Catastrophic Illness Patients Database of Taiwan. We included 1179 patients and 4716 patients from 1999 to 2008 as the DM/PM cohort and the comparison cohort, respectively, and calculated the incidence rates of newly diagnosed osteoporosis. We used Cox proportional hazards models stratified on matched pair to assess the effect of DM/PM. The Kaplan–Meier method was applied to estimate the cumulative osteoporosis incidence curves. Patients with DM/PM were 2.99 times more likely to experience osteoporosis than those without DM/PM. The risk for osteoporosis in DM/PM patients was higher than comparisons in different propensity score quartiles. DM/PM cohort, no matter treated with or without corticosteroids and immunosuppressant, had a higher risk than the comparison cohort. The incidence of osteoporosis in Taiwan is associated with a priori DM/PM history. This risk was independent of the corticosteroids and immunosuppressant treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

BMD:

Bone mineral density

BNHI:

Bureau of National Health Insurance

CIPD:

Catastrophic Illness Patients Database

COPD:

Chronic obstructive pulmonary disease

DM:

Dermatomyositis

DXA:

Dual energy X-ray absorptiometry

IHD:

Ischemic heart disease

IIMs:

Idiopathic inflammatory myopathies

LHID:

Longitudinal Health Insurance Database

NHIRD:

National Health Insurance Research Database

OPD:

Outpatient department

PM:

Polymyositis

References

  1. M.C. Dalakas, R. Hohlfeld, Polymyositis and dermatomyositis. Lancet 362, 971–982 (2003)

    Article  CAS  PubMed  Google Scholar 

  2. A.E. Hak, B. de Paepe, J.L. de Bleecker, P.P. Tak, M. de Visser, Dermatomyositis and polymyositis: new treatment targets on the horizon. Neth. J. Med. 69, 410–421 (2011)

    CAS  PubMed  Google Scholar 

  3. I. Marie, Morbidity and mortality in adult polymyositis and dermatomyositis. Curr. Rheumatol. Rep. 14, 275–285 (2012)

    Article  CAS  PubMed  Google Scholar 

  4. T.D. Rachner, S. Khosla, L.C. Hofbauer, Osteoporosis: now and the future. Lancet 377, 1276–1287 (2011)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. A. Leboime, C.B. Confavreux, N. Mehsen, J. Paccou, C. David, C. Roux, Osteoporosis and mortality. Joint Bone Spine 77, S107–S112 (2010)

    Article  PubMed  Google Scholar 

  6. W.A. Stewart, P.D. Acott, S.R. Salisbury, B.A. Lang, Bone mineral density in juvenile dermatomyositis: assessment using dual X-ray absorptiometry. Arthritis Rheum. 48, 2294–2298 (2003)

    Article  CAS  PubMed  Google Scholar 

  7. K.A. Alsufyani, O. Ortiz-Alvarez, D.A. Cabral, L.B. Tucker, R.E. Petty, H. Nadel, P.N. Malleson, 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, 729–733 (2005)

    CAS  PubMed  Google Scholar 

  8. T.C. Castro, M.T. Terreri, V.L. Szejnfeld, C. Len, A.S. Fonseca, M.O. Hilario, Bone mineral density of Brazilian girls with juvenile dermatomyositis. Braz. J. Med. Biol. Res. 38, 309–313 (2005)

    Article  PubMed  Google Scholar 

  9. D.C. de Andrade, S.C. de Magalhaes Souza, J.F. de Carvalho, L. Takayama, C.T. Borges, J.M. Aldrighi, R.M. Pereira, High frequency of osteoporosis and fractures in women with dermatomyositis/polymyositis. Rheumatol. Int. 32, 1549–1553 (2012)

    Article  PubMed  Google Scholar 

  10. R.A. Santiago, C.A. Silva, V.F. Caparbo, A.M. Sallum, R.M. Pereira, Bone mineral apparent density in juvenile dermatomyositis: the role of lean body mass and glucocorticoid use. Scand. J. Rheumatol. 37, 40–47 (2008)

    Article  CAS  PubMed  Google Scholar 

  11. T.P. van Staa, H.G. Leufkens, C. Cooper, The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis. Osteoporos. Int. 13, 777–787 (2002)

    Article  PubMed  Google Scholar 

  12. R.B. Mazess, G.D. Whedon, Immobilization and bone. Calcif. Tissue Int. 35, 265–267 (1983)

    Article  CAS  PubMed  Google Scholar 

  13. D.L. Kamen, J.D. Alele, Skeletal manifestations of systemic autoimmune diseases. Curr. Opin. Endocrinol. Diabetes Obes. 17, 540–545 (2010)

    Article  CAS  PubMed  Google Scholar 

  14. D. Kamen, C. Aranow, Vitamin D in systemic lupus erythematosus. Curr. Opin. Rheumatol. 20, 532–537 (2008)

    Article  CAS  PubMed  Google Scholar 

  15. S.A. Stechschulte, R.S. Kirsner, D.G. Federman, Vitamin D: bone and beyond, rationale and recommendations for supplementation. Am. J. Med. 122, 793–802 (2009)

    Article  CAS  PubMed  Google Scholar 

  16. J.M. Grossman, R. Gordon, V.K. Ranganath, C. Deal, L. Caplan, W. Chen, J.R. Curtis, D.E. Furst, M. McMahon, N.M. Patkar, E. Volkmann, K.G. Saag, American College of Rheumatology 2010, Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis. Care Res. (Hoboken) 62, 1515–1526 (2010)

    Article  Google Scholar 

  17. D. Liu, A. Ahmet, L. Ward, P. Krishnamoorthy, E.D. Mandelcorn, R. Leigh, J.P. Brown, A. Cohen, H. Kim, A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin. Immunol. 9, 30 (2013)

    Article  PubMed  PubMed Central  Google Scholar 

  18. J.M. Quinn, H. Saleh, Modulation of osteoclast function in bone by the immune system. Mol. Cell. Endocrinol. 310, 40–51 (2009)

    Article  CAS  PubMed  Google Scholar 

  19. S. Kotake, N. Udagawa, M. Hakoda, M. Mogi, K. Yano, E. Tsuda, K. Takahashi, T. Furuya, S. Ishiyama, K.J. Kim, S. Saito, T. Nishikawa, N. Takahashi, A. Togari, T. Tomatsu, T. Suda, N. Kamatani, Activated human T cells directly induce osteoclastogenesis from human monocytes: possible role of T cells in bone destruction in rheumatoid arthritis patients. Arthritis. Rheum. 44, 1003–1012 (2001)

    Article  CAS  PubMed  Google Scholar 

  20. K. Sato, A. Suematsu, K. Okamoto, A. Yamaguchi, Y. Morishita, Y. Kadono, S. Tanaka, T. Kodama, S. Akira, Y. Iwakura, D.J. Cua, H. Takayanagi, Th17 functions as an osteoclastogenic helper T cell subset that links T cell activation and bone destruction. J. Exp. Med. 203, 2673–2682 (2006)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. C.L. Cheng, Y.H. Kao, S.J. Lin, C.H. Lee, M.L. Lai, Validation of the National Health Insurance Research Database with ischemic stroke cases in Taiwan. Pharmacoepidemiol. Drug Saf. 20, 236–242 (2011)

    Article  PubMed  Google Scholar 

  22. W.Q. Gan, S.F. Man, A. Senthilselvan, D.D. Sin, Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and a meta-analysis. Thorax 59, 574–580 (2004)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

This study is supported in part by Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (MOHW104-TDU-B-212-113002); China Medical University Hospital, Academia Sinica Taiwan Biobank, Stroke Biosignature Project (BM104010092); NRPB Stroke Clinical Trial Consortium (MOST 103-2325-B-039 -006); Tseng-Lien Lin Foundation, Taichung, Taiwan; Taiwan Brain Disease Foundation, Taipei, Taiwan; Katsuzo and Kiyo Aoshima Memorial Funds, Japan; and CMU under the Aim for Top University Plan of the Ministry of Education, Taiwan.

Author contributions

The individual contributions of the authors are listed as follows. Conception and design: Cynthia Wei-Sheng Lee and Chia-Hung Kao. Administrative support: Chih-Hsin Muo and Fung-Chang Sung. Data collection and assembly: Cynthia Wei-Sheng Lee, Ji-An Liang, and Chia-Hung Kao. Data analysis and interpretation: Cynthia Wei-Sheng Lee and Chia-Hung Kao. Manuscript writing and final approval of the manuscript: All authors. The guarantor of the paper assumes responsibility for the integrity of the work as a whole: Chia-Hung Kao.

Funding

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. No additional external funding was received for this study.

Author information

Authors and Affiliations

  1. Center for Drug Abuse and Addiction, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan

    Cynthia Wei-Sheng Lee

  2. Department of Public Health, China Medical University and Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

    Chih-Hsin Muo

  3. College of Medicine, China Medical University, Taichung, Taiwan

    Chih-Hsin Muo

  4. Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung, 40447, Taiwan

    Ji-An Liang, Fung-Chang Sung, Chung-Y. Hsu & Chia-Hung Kao

  5. Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan

    Ji-An Liang

  6. Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan

    Chia-Hung Kao

Authors
  1. Cynthia Wei-Sheng Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chih-Hsin Muo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ji-An Liang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fung-Chang Sung
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chung-Y. Hsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Chia-Hung Kao
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chia-Hung Kao.

Ethics declarations

Disclosure statement

All authors state that they have no conflicts of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 30 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, C.WS., Muo, CH., Liang, JA. et al. Increased osteoporosis risk in dermatomyositis or polymyositis independent of the treatments: a population-based cohort study with propensity score. Endocrine 52, 86–92 (2016). https://doi.org/10.1007/s12020-015-0756-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-015-0756-x

Keywords

Search

Navigation