ArticleArthritis & rheumatology (Hoboken, N.J.)2019
Comparative Fracture Risks Among United States Medicaid Enrollees With and Those Without Systemic Lupus Erythematosus.
Article in Arthritis & rheumatology (Hoboken, N.J.), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
23 citing papers in PubMed, 1 synthesis or guideline pooled it, 42 citations in OpenAlex.
- Executive summary: Italian guidelines for diagnosis, risk stratification, and care continuity of fragility fractures 2021.Frontiers in endocrinology · 2023Pooled it
- Management of glucocorticoid-induced osteoporosis in rheumatic diseases.Best practice & research. Clinical rheumatology · 2026Review
- Outcomes Following Single-Level Spinal Fusion in Patients With Systemic Lupus Erythematosus.Cureus · 2026Article
- Fracture risk tools performance and potential use in systemic lupus erythematosus.Lupus science & medicine · 2026Observational
- Low calcium intake from diet and supplements in a group of Polish patients with SLE - an additional risk for osteoporotic fractures?Acta biochimica Polonica · 2026Article
- Understanding the Evidence Gaps in the Epidemiology and Burden of Lupus Nephritis and Membranous Nephropathy: A Targeted Literature Review.Journal of health economics and outcomes research · 2026Review
- Lupus nephritis.Nature reviews. Disease primers · 2025Review
- Prevalence and determinants of vertebral fractures in a SLE cohort.Lupus science & medicine · 2025Observational
- Lupus nephritis and U1-RNP-antibodies are associated with low bone mineral density and osteoporosis in patients with systemic lupus erythematosus: baseline findings in a sub-cohort of patients with inflammatory rheumatic diseases.Arthritis research & therapy · 2025Article
- Systemic lupus erythematosus: updated insights on the pathogenesis, diagnosis, prevention and therapeutics.Signal transduction and targeted therapy · 2025Review
- Osteoporosis and fracture risk are multifactorial in patients with inflammatory rheumatic diseases.Nature reviews. Rheumatology · 2024Review
- Association between systemic lupus erythematosus and osteoporosis: a mendelian randomization analysis.BMC rheumatology · 2024Article
- Association between cause of kidney failure and fracture incidence in a national US dialysis population cohort study.Clinical kidney journal · 2022Article
- Low Serum Calcium Concentration in Patients With Systemic Lupus Erythematosus Accompanied by the Enhanced Peripheral Cellular Immunity.Frontiers in immunology · 2022Article
- Comorbidity and healthcare utilisation in persons with incident systemic lupus erythematosus followed for 3 years after diagnosis: analysis of a claims data cohort.Lupus science & medicine · 2021Article
- Imaging of Joint and Soft Tissue Involvement in Systemic Lupus Erythematosus.Current rheumatology reports · 2021Review
- The Categorization of Pain in Systemic Lupus Erythematosus.Rheumatic diseases clinics of North America · 2021Review
- High Comorbidity Burden in Patients with SLE: Data from the Community-Based Lupus Registry of Crete.Journal of clinical medicine · 2021Article
- Article
- The Emerging Roles of Endocrine Hormones in Different Arthritic Disorders.Frontiers in endocrinology · 2021Review
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
Abstract
objectivePoor bone health is common in systemic lupus erythematosus (SLE) patients. This study was undertaken to evaluate fracture risks among low-income SLE and lupus nephritis patients compared to those without SLE.
methodsWe performed a cohort study among SLE patients for whom there were Medicaid claims in 2007-2010, and age- and sex-matched non-SLE comparators. SLE was defined by the presence of ≥3 International Classification of Diseases, Ninth Revision codes for SLE. Patients with lupus nephritis additionally had ≥2 codes for renal disease. The primary outcome measure was fracture of the pelvis, wrist, hip, or humerus. Demographics, prescriptions, and comorbidities were assessed during the 180-day baseline period. We calculated fracture incidence rates and 95% confidence intervals (95% CIs) in SLE, lupus nephritis, and non-SLE comparator cohorts, and estimated adjusted hazard ratios (HRs) for fractures. Sensitivity analyses evaluated the impact of glucocorticoids and comorbidities. We compared subsets of SLE patients with and those without lupus nephritis.
resultsAmong 47,709 SLE patients (19.8% with lupus nephritis) matched to 190,836 non-SLE comparators, the mean age was 41.4 years and 92.6% were female. The fracture incidence rate was highest among SLE patients with lupus nephritis (4.60 per 1,000 person-years). SLE patients had 2-fold higher fracture risks than matched comparators (HR 2.09 [95% CI 1.85-2.37]; P < 0.01). Lupus nephritis patients had the greatest fracture risks versus matched comparators (HR 3.06 [95% CI 2.24-4.17]; P < 0.01), and had a 1.6 times higher fracture risk than SLE patients without nephritis (HR 1.58 [95% CI 1.20-2.07]; P < 0.01). Adjustment for glucocorticoid use and comorbidities slightly attenuated risks.
conclusionFracture risks were increased in SLE patients, particularly those with lupus nephritis, compared to matched non-SLE Medicaid recipients. Increased risks persisted after adjustment for baseline glucocorticoid treatment and comorbidities.
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