[Osteoporosis treatment in systemic sclerosis : Challenges and strategies in daily clinical practice]

Systemic sclerosis (SSc) is a complex autoimmune disease with multiorgan involvement and substantial morbidity and mortality. As a result, patients with SSc are disproportionately affected by osteoporosis, which remains insufficiently characterized in the context of SSc and is often underrecognized in clinical practice.

To present the current state of evidence regarding the epidemiology, pathophysiological mechanisms, diagnostic features, and therapeutic challenges of osteoporosis in the context of SSc.

Narrative review of relevant primary and secondary literature (2003-2025) from PubMed, Embase, and current guideline sources, focusing on osteological aspects in SSc.

Patients with SSc exhibit a significantly increased prevalence of osteoporosis and fractures. SSc aggravates osteoporosis risk factors such as postmenopausal status, malnutrition and low body weight through vasculopathy, fibrosis, as well as autoimmunity/inflammatory activity. The trabecular bone score (TBS) serves as a useful adjunct in fracture risk assessment. Furthermore, SSc complicates, especially due to gastrointestinal involvement, osteospecific therapy, with oral bisphosphonates appearing less effective. Preliminary evidence supports the effectiveness of parenteral antiresorptive agents.

Osteoporosis in SSc requires disease-specific risk assessment and an individualized diagnostic and therapeutic approach. Further prospective studies are needed to establish evidence-based treatment recommendations.