The effect of dehydroepiandrosterone on lumbar spine bone mineral density in patients with quiescent systemic lupus erythematosus

Background:Osteoporosis is a common comorbidity in patients with systemic lupus erythematosus (SLE). Available evidence showed that autoimmunity and associated inflammation play main effect in the pathogenesis of negative skeletal effects in SLE patients. However, the potential contribution of disease-associated factors to bone status in SLE is not well known since the reported risk factors from different studies differ greatly.Objectives:The aim of this study was to examine frequency of reduced bone mass in SLE women, and determine their potential associations with disease activity, damage accrual and SLE-related clinical markers.Methods:A cross-sectional study including a total 121 Caucasian pre-menopausal and postmenopausal women was conducted (mean age 49.29±12.43 years). The SLE Disease Activity Index (SLEDAI-2K) and the SDI Damage Index were used to asses disease activity and disease-related damage, respectively. Bone mineral density (BMD) of the left femoral neck and lumbar spine (L2–L4) were measured by dual-energy X-ray absorptiometry (Hologic QDR 400).Results:Ten patients (8.3%) had osteoporosis, 63 (52.1%) patients had osteopenia and 6.8% of women had history of previous fracture. Patients with low bone mass had a significantly higher mean SDI (1.36±1.26 versus 0.70±1.09 p=0.003). T-score at lumbar spine was inversely correlated with SDI score (r=-0.222, p=0.014) and complement C3 level (r=-0.206, p=0.024). Results of bivariate correlations showed that T-score at lumbar spine was inversely correlated with SDI score (r=-0.222, p=0.014) and complement C3 level (r=-0.206, p=0.024). SDI scores were significantly different between patients with osteoporosis, osteopenia and normal BMD after adjusting for age, menstrual status, BMI, time since diagnosis and corticoid use (p=0.004).Conclusion:There is a high prevalence of low BMD in Caucasian women with SLE and this status of osteopenia/osteoporosis was associated with higher damage accrual scores, supporting that disease damage may itself be a major contributor to the low BMD. SLE women with organ damage require regular bone status monitoring to prevent further musculoskeletal damage. Since diminished BMD is a main comorbidity it is therefore essential to study, monitor and prevent osteoporosis in SLE women to avoid fractures leading to reduced quality of life.References:[1]Wang X, Yan S, Liu C, Xu Y, Wan L, Wang Y, et al. Fracture risk and bone mineral density levels in patients with systemic lupus erythematosus: a systematic review and meta-analysis. Osteoporos Int 2016;27:1413–23.[2]Mendoza-Pinto C, Rojas-Villarraga A, Molano-Gonzalez N, Jimenez-Herrera EA, De La Luz Leon-Vazquez M, Montiel-Jarquõn A, et al. Bone mineral density and vertebral fractures in patients with systemic lupus erythematosus: A systematic review and meta-regression. PLoS One 2018;13:1–15.[3]Xia J, Luo R, Guo S, Yang Y, Ge S, Xu G, et al. Prevalence and Risk Factors of Reduced Bone Mineral Density in Systemic Lupus Erythematosus Patients: A Meta-Analysis. Biomed Res Int 2019;2019.[4]Carli L, Tani C, Spera V, Vagelli R, Vagnani S, Mazzantini M, et al. Risk factors for osteoporosis and fragility fractures in patients with systemic lupus erythematosus. Lupus Sci Med 2016;3:1–5.Acknowledgements:This research was supported by the grant PI0523-2016 from “Consejería de igualdad, salud y políticas sociales” (Junta de Andalucía) and is part of the research group LyDIMED “Lupus y Dieta Mediterránea”.Disclosure of Interests:None declared

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Bone Mineral Density Change in Systemic Lupus Erythematosus: A 5-year Followup Study

The Journal of Rheumatology ◽

10.3899/jrheum.131190 ◽

2014 ◽

Vol 41 (10) ◽

pp. 1990-1997 ◽

Cited By ~ 21

Author(s):

Tracy Y. Zhu ◽

James F. Griffith ◽

Sze-Ki Au ◽

Xiao-Lin Tang ◽

Anthony W. Kwok ◽

...

Keyword(s):

Bone Mineral Density ◽

Systemic Lupus Erythematosus ◽

Lumbar Spine ◽

Femoral Neck ◽

Bone Mineral ◽

Lupus Erythematosus ◽

Organ Damage ◽

Mineral Density ◽

Systemic Lupus ◽

Total Hip

Objective.To determine changes of bone mineral density (BMD) over a 5-year period in a cohort of female patients with systemic lupus erythematosus (SLE) and to identify factors predictive of BMD loss.Methods.Our longitudinal study involved 125 female patients with SLE with a mean (SD) age of 46.5 years (10.1) and a median disease duration of 10.4 years. Demographics and clinical data were collected and BMD at the femoral neck, total hip, and lumbar spine (L1-4) was performed by using dual-energy x-ray absorptiometry at baseline and followup.Results.Average percentage changes of BMD over a mean followup of 5 years were −2.41% at the femoral neck, −1.63% at the total hip, and −0.62% at the lumbar spine, with significant changes at both the femoral neck (p < 0.0001) and total hip (p < 0.0005), but not at the lumbar spine (p = 0.128). Disease flare, new organ damage, and use of glucocorticoids during followup were significantly associated with larger decreases in BMD. BMD loss was arrested at the femoral neck and BMD increased at the total hip and lumbar spine in patients receiving antiosteoporosis therapy. In multivariate analyses, use of antiosteoporosis therapy was independently associated with increased BMD at any site and new organ damage was an independent predictor of BMD loss at the femoral neck.Conclusion.Significant BMD loss at the hip over a period of 5 years was found in patients with SLE. Disease activity, disease damage, and use of glucocorticoids are the disease-specific variables that contribute to bone loss in SLE.

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Spine bone mineral density (BMD) in children and adolescents affected with juvenile systemic lupus erythematosus (JSLE)

Bone ◽

10.1016/j.bone.2006.12.048 ◽

2007 ◽

Vol 40 (3) ◽

pp. S16

Author(s):

C Tau ◽

R Russo ◽

MM Katsicas

Keyword(s):

Bone Mineral Density ◽

Systemic Lupus Erythematosus ◽

Children And Adolescents ◽

Bone Mineral ◽

Lupus Erythematosus ◽

Spine Bone Mineral Density ◽

Mineral Density ◽

Systemic Lupus ◽

Juvenile Systemic Lupus Erythematosus

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Disease Damage Accrual and Low Bone Mineral Density in Female Patients with Systemic Lupus Erythematosus

Biological Research For Nursing ◽

10.1177/10998004211005550 ◽

2021 ◽

pp. 109980042110055

Author(s):

María Correa-Rodríguez ◽

Gabriela Pocovi-Gerardino ◽

José-Luis Callejas-Rubio ◽

Raquel Ríos-Fernández ◽

Blanca Rueda-Medina ◽

...

Keyword(s):

Bone Mineral Density ◽

Systemic Lupus Erythematosus ◽

Lumbar Spine ◽

Bone Mass ◽

Disease Activity ◽

Lupus Erythematosus ◽

Mineral Density ◽

Systemic Lupus ◽

Damage Accrual ◽

Disease Damage

Osteoporosis is a common comorbidity in patients with systemic lupus erythematosus (SLE), but the potential contribution of disease-associated factors to bone status in SLE is not well known because the reported risk factors from different studies differ greatly. We aimed to examine frequency of reduced bone mass in women with SLE, and determine their potential associations with disease activity, damage accrual and SLE-related clinical markers. A cross-sectional study including 121 Caucasian pre-menopausal and postmenopausal women was conducted (mean age 49.2 ± 12.4 years). The SLE Disease Activity Index (SLEDAI-2 K) and the SDI Damage Index were used to assess disease activity and disease-related damage, respectively. Bone mineral density (BMD) of the left femoral neck and lumbar spine (L2–L4) were measured by dual-energy X-ray absorptiometry. Ten patients (8.3%) had osteoporosis, 63 (52.1%) patients had osteopenia and 6.8% of women had history of previous fracture. Patients with low bone mass had a significantly higher mean SDI (1.3 ± 1.2 versus 0.7 ± 1.0 p = 0.003). T-score at lumbar spine was inversely correlated with SDI score (r = -0.222, p = 0.014) and complement C3 level ( r = −0.206, p = .024). SDI scores were significantly different between patients with osteoporosis, osteopenia, and normal BMD after adjusting for covariates ( p = .004). There is a high prevalence of low BMD in Caucasian women with SLE, and this status was associated with higher damage accrual scores, supporting that disease damage may itself be a major contributor to the low BMD. Women with SLE with organ damage require regular bone status monitoring to prevent further musculoskeletal damage.

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