Prevalence of and risk factors for low bone mineral density and vertebral fractures in patients with systemic lupus erythematosus

Department of Rheumatology, VU University Medical Center, Slotervaart Hospital, and Jan van Breemen Institute, Amsterdam, The Netherlands.
Arthritis & Rheumatology (Impact Factor: 7.76). 07/2005; 52(7):2044-50. DOI: 10.1002/art.21110
Source: PubMed

ABSTRACT To examine the prevalence of and risk factors for low bone mineral density (BMD) and vertebral fractures in patients with systemic lupus erythematosus (SLE).
We studied 107 SLE patients. Demographic and clinical data were collected, and radiographs of the thoracic and lumbar spine and BMD measurements by dual x-ray absorptiometry were performed. Vertebral deformities were scored according to the method of Genant et al: fractures were defined as a reduction of > or = 20% of the vertebral body height. Osteoporosis was defined as a T score less than -2.5 SD and osteopenia as a T score less than -1.0 SD in at least 1 region of measurement.
Osteopenia was present in 39% of the patients and osteoporosis in 4% (93% female; mean age 41.1 years). In multiple regression analysis, low BMD in the spine was associated with a low body mass index (BMI), postmenopausal status, and 25-hydroxyvitamin D deficiency. Low BMD in the hip was associated with low BMI and postmenopausal status. At least 1 vertebral fracture was detected in 20% of the patients. Vertebral fractures were associated with ever use of intravenous methylprednisolone and male sex.
Risk factors for low BMD in SLE patients are low BMI, postmenopausal status, and vitamin D deficiency. While osteoporosis defined as a low T score was found in only 4% of the patients, osteoporotic vertebral fractures were detected in 20%. The high prevalence of low BMD and vertebral fractures implies that more attention must be paid to the prevention and treatment of osteoporosis and fractures in SLE.

26 Reads
  • Source
    • "Chronic inflammatory diseases are frequently associated with systemic bone loss, whose pathogenesis is extremely complex and involves different mechanisms that are strictly interrelated. The relationship between inflammation and bone loss has been clearly established in many clinical and experimental models [1–4]. Particularly, many studies have focused on systemic bone loss that occurs in various chronic inflammatory diseases currently observed in clinical practice, such as inflammatory bowel diseases, chronic lung inflammation, vasculitis, connective tissue diseases, and inflammatory joint diseases [5–7]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Biologic agents used in the treatment of rheumatoid arthritis (RA) are able to reduce both disease activity and radiographic progression of joint disease. These drugs are directed against several proinflammatory cytokines (TNF α , IL-6, and IL-1) which are involved both in the pathogenesis of chronic inflammation and progression of joint structural damage and in systemic and local bone loss typically observed in RA. However, the role of biologic drugs in preventing bone loss in clinical practice has not yet clearly assessed. Many clinical studies showed a trend to a positive effect of biologic agents in preventing systemic bone loss observed in RA. Although the suppression of inflammation is the main goal in the treatment of RA and the anti-inflammatory effects of biologic drugs exert a positive effect on bone metabolism, the exact relationship between the prevention of bone loss and control of inflammation has not been clearly established, and if the available biologic drugs against TNF α , IL-1, and IL-6 can exert their effect on systemic and local bone loss also through a direct mechanism on bone cell metabolism is still to be clearly defined.
    Clinical and Developmental Immunology 06/2013; 2013(6877):945945. DOI:10.1155/2013/945945 · 2.93 Impact Factor
  • Source
    • "In line with findings in the general population, two studies in lupus patients showed that white [9] or non-African Caribbean ethnicity [10] was a risk factor for osteoporosis, while another study demonstrated reduced bone mineral density (BMD) in African American women with SLE compared with white patients after controlling for clinical variables and after adjusting for glucocorticoid (GC) use [11]. Smoking is not reported as a risk factor for osteoporosis in SLE [6, 8, 10] but has recently been identified as a risk factor for osteoporotic fractures in a study from the Hopkins Lupus Cohort [12]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Inflammatory joint diseases such as rheumatoid arthritis, as well as other rheumatic conditions, such as systemic lupus erythematosus (SLE) and ankylosing spondylitis, comprise a heterogeneous group of joint disorders that are all associated with extra-articular side effects, including bone loss and fractures. The concept of osteoimmunology is based on growing insights into the links between the immune system and bone. The pathogenesis of osteoporosis in these patients is multifactorial. We have, more or less as an example, described this extensively for patients with SLE. High disease activity (inflammation) and immobility are common factors that substantially increase fracture risk in these patients, on top of the background fracture risk based on, among other factors, age, body mass index, and gender. Although no fracture reduction has been shown in intervention studies in patients with inflammatory rheumatic diseases, we present treatment options that might be useful for clinicians who are treating these patients.
    Current Rheumatology Reports 04/2012; 14(3):224-30. DOI:10.1007/s11926-012-0252-8 · 2.87 Impact Factor
  • Source
    • "Vitamin D represents an appealing therapy in pediatric rheumatic diseases. Its myriad effects may both minimize disease-related comorbidities such as bone fragility [31], accelerated cardiovascular disease, and infections and attenuate the immune hyperactivation that is characteristic of conditions such as pediatric SLE [32•] and multiple sclerosis. In pediatric SLE patients with 25(OH)D less than 20 ng/mL, the SLE Disease Activity Index scores were significantly higher. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Vitamin D is capturing the attention of healthy and chronically ill populations for its potential skeletal and nonskeletal benefits. New information suggesting a role in immune modulation has led to a surge of interest among rheumatologists. Although the epidemiologic data are limited, it appears that many children with rheumatic conditions are at risk of vitamin D deficiency. However, understanding this phenomenon requires an appreciation for how vitamin D status is assessed, and options for supplementation. Although a "more-is-better" attitude is tempting when considering the medicinal effects of a nutritional supplement, we suggest a cautious approach and suggest that further studies are needed to clarify the potential benefits and risks among children with rheumatic conditions.
    Current Rheumatology Reports 04/2011; 13(2):110-6. DOI:10.1007/s11926-010-0161-7 · 2.87 Impact Factor
Show more