Background Observational studies have indicated a high but heterogeneous prevalence of low bone mineral density (BMD) and vertebral fractures (VR) in patients with systemic lupus erythematosus (SLE).
Objectives To evaluate the relationship between SLE and BMD, osteoporosis and the risk of vertebral fracture.
Methods A systematic review and meta-regression analyses were carried out according to the Preferred Reporting Items for Systematic Meta-Analyses (PRISMA) guidelines. Articles were identified from electronic databases (PubMed, Embase, VHL, SciELO and the Cochrane Library). The search was conducted using MesH terms, Boolean operators and keywords, which included “systemic lupus erythematosus”, “osteoporosis”, “bone mineral density”, and “vertebral fractures”. Prospective longitudinal and cross-sectional studies were considered for review without language restrictions. Articles were screened for suitability. Those selected were evaluated by two investigators, who extracted information on study characteristics, outcomes of interest, and risk of bias, and summarized the strength of evidence. Data was extracted when studies met inclusion criteria and were of sufficient quality. BMD, reported as the mean ± standard deviation evaluated by dual-energy X-ray absorptiometry (DXA), was analyzed including information on SLE cases and controls, treatment, menopausal status and fractures by meta-regression analysis adjusted by anatomical region. Data were analyzed using the Metafor package in R (3.0.2 version).
Results In total 49 articles were identified and analyzed (12, 593 SLE cases/six anatomical regions and 14,235 controls/six anatomical regions). SLE women, but not SLE men, had a lower BMD than healthy controls (p<0.0001). When only SLE patients were analyzed, the BMD did not significantly differ between patients who had or had not received corticosteroid (CTS) therapy. Unsurprisingly, postmenopausal SLE patients had a lower BMD (lumbar spine and total hip) compared with premenopausal patients (p<0.0001). The BMD did not differ in patients with and without fractures.
Conclusions This systematic review and meta-regression analysis shows that women with SLE had a higher risk of low BMD than healthy controls. The data did not show that CTS therapy had an impact on BMD.
Bultink IE. Osteoporosis and fractures in systemic lupus erythematosus. Arthritis Care Res (Hoboken). 2012;64:2–8.
Acknowledgement We would like to thank David Buss for his valuable guidance and advice during this project.
Disclosure of Interest None declared