Comorbid Fibromyalgia in SLE patients Increases Falls and Fracture Risk: Study

A new research published in the journal of Lupus Science & Medicine found that patients with systemic lupus erythematosus (SLE) and comorbid fibromyalgia had a >50% higher risk of recurrent falls and a >30% higher risk of first-time falls when compared to patients with SLE alone. Fibromyalgia was also associated with increased risks of thoracolumbar vertebral and osteoporotic fractures, with the excess risk appearing early and persisting over 5 years.

Fibromyalgia is widely recognized for causing chronic widespread pain, fatigue and impaired physical function, while SLE is a systemic autoimmune disease that can affect multiple organs. Despite the two conditions frequently occurring together, it has remained uncertain whether fibromyalgia independently contributes to adverse musculoskeletal outcomes in lupus patients.

This research analyzed data from the TriNetX US Collaborative Network, conducting a retrospective cohort study that compared adults with both SLE and fibromyalgia (SLE+FM) against matched patients with SLE alone. To ensure a fair comparison, investigators used propensity score matching, balancing the two groups for demographics, existing medical conditions, laboratory findings and the use of 19 different medications. A 6-month washout period was also applied before tracking outcomes, ensuring that only new fall and fracture events were included in the analysis.

After matching, the study included 23,775 patients in each group. The participants were followed for up to five years to examine the incidence of falls, recurrent falls, thoracolumbar vertebral fractures and osteoporotic fractures.

When compared with patients who had lupus alone, those with SLE and fibromyalgia were 38% more likely to experience an initial fall and 53% more likely to suffer recurrent falls over the 5-year follow-up period. The combined condition was also associated with an 18% higher risk of thoracolumbar vertebral fractures and a 14% higher risk of osteoporotic fractures.

The elevated risks emerged early in the follow-up period and continued to widen over time, as demonstrated by Kaplan-Meier survival analyses. The associations remained consistent at 3 years and across all predefined patient subgroups, which reinforced the robustness of the findings.

These findings recommend incorporating fibromyalgia screening into routine fall risk assessments for people with lupus and adopting multidisciplinary approaches that combine fall-prevention measures with strategies to protect bone health. Such interventions may include balance and strength training, physical therapy, osteoporosis screening and appropriate bone-preserving treatments. Early recognition and targeted preventive care could help reduce these potentially disabling complications and improve long-term outcomes for individuals living with both chronic conditions.

Reference:

Hsu, W.-Y., Tsai, L.-Y., Lai, C.-Y., Chen, J.-P., Kao, C.-M., Chen, Y.-J., Chen, I.-C., & Chen, Y.-M. (2026). Risk of falls, recurrent falls and osteoporotic fractures in SLE patients with comorbid fibromyalgia: a propensity score-matched cohort study using the TriNetX Network. Lupus Science & Medicine, 13(2), e002188. https://doi.org/10.1136/lupus-2026-002188