Systemic Lupus Erythematosus (SLE) is a chronic multisystem autoimmune disease that usually affects women during the childbearing ages. Because survival of SLE patients has improved dramatically over the last decades, attention is now more focused on complications of the disease and/or its treatment, that contribute to increased morbidity and mortality.
Osteoporosis and fractures are important disease complications in patients with SLE. In recent studies, a high frequency of low bone mineral density and both peripheral and vertebral fractures has been demonstrated in SLE patients. The incidence of symptomatic fractures is increased 1.2 to 4.7-fold in patients with SLE . In addition, prevalent vertebral fractures are present in 20-26% of these relatively young patients .
The etiology of bone loss in SLE is supposed to be multifactorial, involving traditional osteoporosis risk factors, inflammation, metabolic factors, serological factors, hormonal factors, and medication-induced adverse effects .
A recent 6-year follow-up study in Dutch SLE patients revealed, that low 25-hydroxyvitamin D serum levels at baseline, low body mass index and baseline use of antimalarial drugs were associated with bone loss . In addition, a dose-dependent relationship between glucocorticoid use and spine bone loss was demonstrated. The results of this study have implications for daily clinical practice, because low 25-hydroxyvitamin D levels are highly frequent in SLE patients, antimalarials are “anchor drugs” for the treatment of SLE, and the majority of SLE patients is on chronic glucocorticoid treatment.
Importantly, several risk factors associated with osteoporosis in SLE are modifiable by lifestyle measures or medication.
Bultink IEM et al. Osteoporos Int 2013 Dec 3 [Epub ahead of print]
Bultink IE. Arthritis Care Res (Hoboken) 2012;64:2-8
Jacobs J et al. Osteoporos Int 2013;24:1827-33
Disclosure of Interest I. Bultink Consultant for: Servier Laboratories; Merck & Co