{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T12:24:28Z","timestamp":1777983868927,"version":"3.51.4"},"reference-count":20,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2022,12,8]],"date-time":"2022-12-08T00:00:00Z","timestamp":1670457600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Scleroderma and Related Disorders"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:p>This case\u2013control study analyzed risk factors for symptomatic fractures in a group of 52 patients with systemic sclerosis compared with a group of 104 patients without fractures, matched for sex and age, who were attended at a single systemic sclerosis outpatient clinic from 2010 to 2020. Fractures affected predominantly vertebral (65.4%), rib (13.5%), and hip (7.7%) joints, while the mean age of fracture was 55.3\u2009\u00b1\u20099.5\u2009years. Age at disease onset, age at diagnosis, disease duration, age at menarche, and age at menopause were similar in both groups, and 58.9% of the patients were menopausal at the time of the fracture. The presence of fractures had a significant association with densitometric osteoporosis (p\u2009&lt;\u20090.001), lower weight (p\u2009=\u20090.032), and bone mineral index (p\u2009=\u20090.044), anti-RNA polymerase III (p\u2009=\u20090.040), use of corticosteroids (p\u2009=\u20090.019), and bisphosphonates (p\u2009&lt;\u20090.001), as well as with densitometric T-scores of lumbar spine (p\u2009&lt;\u20090.001), femoral neck (p\u2009=\u20090.025), and total hip (p\u2009=\u20090.013). Multivariate analysis showed that the variables significantly associated with fractures were high doses of corticosteroids (odds ratio\u2009=\u20094.10; 95% confidence interval = 1.290\u201313.090; p\u2009=\u20090.017), bisphosphonates (odds ratio\u2009=\u20093.91; 95% confidence interval = 1.699\u20138.984; p\u2009=\u20090.001), negative anti-Scl70 (OR\u2009=\u20090.34; 95% confidence interval = 0.124\u20130.943; p\u2009=\u20090.038), and lumbar T-score (odds ratio\u2009=\u20090.39; 95% confidence interval = 0.034\u20130.460; p\u2009=\u20090.010). In conclusion, symptomatic fractures were associated predominantly with lower bone mineral density of lumbar spine and use of high doses of corticosteroids and bisphosphonates in this cohort.<\/jats:p>","DOI":"10.1177\/23971983221141271","type":"journal-article","created":{"date-parts":[[2022,12,8]],"date-time":"2022-12-08T23:34:05Z","timestamp":1670542445000},"page":"79-84","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Symptomatic fractures in systemic sclerosis: A case\u2013control study"],"prefix":"10.1136","volume":"8","author":[{"given":"Mar\u00edlia M","family":"Sampaio-Barros","sequence":"first","affiliation":[{"name":"Disciplina de Reumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de S\u00e3o Paulo, Sao Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adriana B","family":"Bortoluzzo","sequence":"additional","affiliation":[{"name":"Insper\u2014Instituto de Educa\u00e7\u00e3o e Pesquisa, Sao Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henrique Carri\u00e7o","family":"da Silva","sequence":"additional","affiliation":[{"name":"Disciplina de Reumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de S\u00e3o Paulo, Sao Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0516-6918","authenticated-orcid":false,"given":"Ana Paula","family":"Luppino-Assad","sequence":"additional","affiliation":[{"name":"Disciplina de Reumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de S\u00e3o Paulo, Sao Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosa Maria R","family":"Pereira","sequence":"additional","affiliation":[{"name":"Disciplina de Reumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de S\u00e3o Paulo, Sao Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9843-6686","authenticated-orcid":false,"given":"Percival D","family":"Sampaio-Barros","sequence":"additional","affiliation":[{"name":"Disciplina de Reumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de S\u00e3o Paulo, Sao Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,12,8]]},"reference":[{"key":"bibr1-23971983221141271","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30933-9"},{"key":"bibr2-23971983221141271","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.130032"},{"key":"bibr3-23971983221141271","doi-asserted-by":"publisher","DOI":"10.1080\/03009740600704296"},{"key":"bibr4-23971983221141271","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0066991"},{"key":"bibr5-23971983221141271","doi-asserted-by":"publisher","DOI":"10.1002\/acr.21761"},{"key":"bibr6-23971983221141271","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-204832"},{"key":"bibr7-23971983221141271","doi-asserted-by":"publisher","DOI":"10.1007\/s00223-016-0119-5"},{"key":"bibr8-23971983221141271","doi-asserted-by":"publisher","DOI":"10.1016\/j.rbr.2016.03.004"},{"key":"bibr9-23971983221141271","doi-asserted-by":"publisher","DOI":"10.1186\/s13075-019-2072-y"},{"key":"bibr10-23971983221141271","doi-asserted-by":"publisher","DOI":"10.1111\/1756-185X.14254"},{"key":"bibr11-23971983221141271","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-204424"},{"issue":"2","key":"bibr12-23971983221141271","first-page":"202","volume":"15","author":"Leroy 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