TOPLINE

Patients with systemic lupus erythematosus (SLE) and comorbid fibromyalgia had more than 50% higher risk for recurrent falls and more than 30% higher risk for incident falls compared with matched patients with SLE but no fibromyalgia. Comorbid fibromyalgia was also associated with increased risk for thoracolumbar vertebral fractures and osteoporotic fractures, with the excess risk emerging early in follow-up and persisting throughout 5 years.

METHODOLOGY

• Researchers conducted a propensity score-matched retrospective cohort study using the TriNetX US Collaborative Network to determine the association between comorbid fibromyalgia and the risk for falls and fractures in patients with SLE.
• After matching on demographics, comorbidities, laboratory parameters, and 19 medications, a total of 23,775 matched pairs of adult patients (SLE plus fibromyalgia vs only SLE) were retained for analysis.
• The mean age of the cohort was around 49 years, and approximately 96% were women.
• Patients were required to have at least 12 months of longitudinal electronic health record data prior to the index date (defined as the first fibromyalgia diagnosis date for the SLE with fibromyalgia group and the first SLE diagnosis date for the SLE-only group), followed by a 6-month washout period before outcome ascertainment commenced.
• Primary outcomes included incident falls, recurrent falls (defined as ≥ 2 fall events on distinct encounter dates), thoracolumbar vertebral fractures, and osteoporotic fractures, ascertained over 5 years using standard diagnostic codes.

TAKEAWAY

• At 5 years, patients with SLE plus fibromyalgia had significantly elevated risks of incident falls (adjusted hazard ratio [aHR], 1.38; 95% CI, 1.29-1.48), recurrent falls (aHR, 1.53; 95% CI, 1.32-1.76), thoracolumbar vertebral fractures (aHR, 1.18; 95% CI, 1.01-1.37), and osteoporotic fractures (aHR, 1.14; 95% CI, 1.02-1.27) compared with the SLE-only group; the excess risk was greatest for recurrent falls.
• Associations were directionally consistent at 3 years and across all prespecified subgroups stratified by age, sex, race/ethnicity, glucocorticoid use, and hydroxychloroquine use.
• Further analysis showed early and progressive divergence between cohorts from the start of follow-up.
• Exploratory analyses of individual fracture sites showed no statistically significant differences in hip, distal radius, or proximal humerus fractures, suggesting that the excess fracture risk associated with fibromyalgia in SLE may be unevenly distributed and more concentrated in the spine than in the limbs.

IN PRACTICE

"Fall risk assessment in SLE patients should incorporate FM [fibromyalgia] evaluation alongside multidisciplinary bone-protective and fall-prevention strategies to reduce fracture-related morbidity in this population," the authors wrote.

SOURCE

The study was led by Wan-Yun Hsu, Taichung Veterans General Hospital in Taichung, Taiwan. It was published online on July 27 in Lupus Science & Medicine.

LIMITATIONS

This study could not prove causality. Quantitative bone mineral density is not reliably recorded as a structured variable in the TriNetX database. Several inputs to formal fracture-risk tools were unavailable.

DISCLOSURES

The authors reported no specific funding for this research from any funding agency in the public, commercial, or not-for-profit sectors. They reported no relevant conflicts of interest.