A Retrospective Analysis of Longitudinal Changes in Bone Mineral Density in Women with Systemic Lupus Erythematosus

Mendoza‐Pinto, Claudia; Garcı́a-Carrasco, Mario; Juárez-Melchor, Daniela; Munguía‐Realpozo, Pamela; Etchegaray‐Morales, Ivet; Santiago-Martín, Nicolás; Ayón-Aguilar, Jorge; Méndez‐Martínez, Socorro

doi:10.1007/s00223-021-00845-0

Cited by 5 publications

(2 citation statements)

References 39 publications

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“…16 Determinants for both low bone mineral density (BMD) and VFs in SLE have been attributed to a combination of the direct effects of the disease and medication to treat it, notably GC. [17][18][19] Although recommendations for monitoring SLE-specific bone status are absent, expert opinion advises that regular osteoporosis screening and particular BMD measurements be incorporated as a quality indicator for reasonable SLE care. 20 Previously, studies on rheumatoid arthritis (RA) exhibited that adequate disease activity control, with a treat-to-target approach, may protect against BMD loss and VF.…”

Section: Introductionmentioning

confidence: 99%

Low disease activity state associated with fewer incident vertebral fractures in Mestizo women with systemic lupus erythematosus

Mendoza-Pinto,

Etchegaray-Morales,

Munguía-Realpozo

et al. 2023

Lupus

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Background Low disease activity state (LDAS) has been linked to a significant reduction in flares and damage accrual in patients with systemic lupus erythematosus (SLE); however, the effect of LDAS on the risk of vertebral fractures (VFs) in subjects with SLE is unknown, considering that low bone mineral density (BMD) and VF are frequent in SLE. Objective to evaluate whether achieving LDAS ≥50% of the observation time prevents new VF and BMD changes in Mestizo women. Methods We carried out a longitudinal, observational, and retrospective study. Mestizo women with SLE were included for a median of an 8-year follow-up. LDAS was described as Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) score ≤4, prednisone ≤7.5 mg/day, and stable immunosuppressive therapies. BMD measurements and lateral thoracic and lumbar radiographs for a semiquantitative analysis for VF were assessed at baseline and during the follow-up. Uni- and multivariable interval-censored survival regression models were carried out. Results We included 110 patients: 35 (31.8%) had new VF. A total of 56 patients (50.1%) achieved LDAS ≥50% of the time during the follow-up and achieved a significantly lesser risk of incident VF (HR = 0.16; 95% CI, 0.06–0.49). After adjusting by age, BMI, menopause, prevalent VF, baseline BMD, cumulative glucocorticoid use, and anti-osteoporotic therapy, LDAS-50 was significantly related to a decrease in the risk of a new VF (HR = 0.39; 95% CI, 0.16–0.98). There was no association between LDAS and BMD measurement changes. When only patients on LDAS but not in remission ( n = 43) were evaluated for the risk of incident VF, both uni- and multivariate analyses were significant (HR = 0.12; 95 CI, 0.04–47; p = 0.001, and HR = 0.26; 95% CI, 0.7–0.88; p = 0.03). Conclusions LDAS ≥50% of the time was significantly associated with a diminished risk of new VF in Mestizo women with SLE, even in patients not in remission. However, LDAS did not help modify BMD changes over time.

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Section: Introductionmentioning

confidence: 99%

Low disease activity state associated with fewer incident vertebral fractures in Mestizo women with systemic lupus erythematosus

Mendoza-Pinto,

Etchegaray-Morales,

Munguía-Realpozo

et al. 2023

Lupus

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“…Vitamin D status of the body could be a potential indicator to help guide the treatment with MMF, which is based on the rationale that bone metabolism is one of the main concerns during the treatment of SLE and the use of immunosuppressants should be appropriate to avoid the negative effect on homeostasis of other systems [24][25][26][27]. However, limited research has looked into the relationship between MMF treatment effect and vitamin D levels in patients with SLE.…”

Section: Introductionmentioning

confidence: 99%

Mycophenolic Acid Exposure Optimization Based on Vitamin D Status in Children with Systemic Lupus Erythematosus: A Single-Center Retrospective Study

Wang

Huang

et al. 2021

Rheumatol Ther

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Introduction: Systemic lupus erythematosus (SLE) can affect bone metabolism and homeostasis of serum electrolytes that are associated with abnormal levels of vitamin D. Mycophenolate mofetil (MMF) is a commonly used immunosuppressant with the active metabolite mycophenolic acid (MPA). The area under the plasma concentration-time curve (AUC) of MPA is often monitored during the treatment to assess the exposure levels. This study aims to explore the association between exposure levels of MPA and 25-hydroxyvitamin D [25(OH)D] levels in children with SLE. Methods: Repeated measured data of children with SLE who were treated with MMF and under therapeutic drug monitoring (TDM) were retrospectively collected from the electronic medical records. MPA exposure levels were reflected by the area under the concentration-time curve over 24 h (AUC 0-24h ). Univariate and multivariate linear regression models were employed to analyze factors associated with 25(OH)D levels. Hierarchical linear models were developed to analyze the intra-and inter-individual effects of AUC 0-24h on the variance of 25(OH)D levels. Results: Data from 184 children with SLE (142 female and 42 male) with 518 follow-ups were collected. The median age was 14 years (range 3-18 years) at TDM. Children with normal 25(OH)D levels had significantly higher AUC 0-24h than children with low 25(OH)D levels (98.71 vs. 84.05 mgÁh/L, P = 0.004). Intraand inter-individual effects of AUC 0-24h on 25(OH)D levels were similar (c 10 = 0.034 vs. c 01 = 0.037) but only the intra-individual effect was significant (P = 0.001) in hierarchical models. Other associated factors include age, sex, season at measurement, glucocorticoid daily dose, and external vitamin D 3 supplements. Conclusion: 25(OH)D levels are associated with MPA exposure levels, and may serve as a potential indicator to optimize the exposure level of MPA during treatment. AUC 0-24h of 98.71 mgÁh/L or AUC 0-12h of 49.36 mgÁh/L could be the targeted exposure level for children with SLE.

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The Relationship Between Systemic Lupus Erythematosus and Osteoporosis Based on Different Ethnic Groups: a Two-Sample Mendelian Randomization Analysis

Shi,

Yuan,

et al. 2024

Calcif Tissue Int

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A Retrospective Analysis of Longitudinal Changes in Bone Mineral Density in Women with Systemic Lupus Erythematosus

Cited by 5 publications

References 39 publications

Low disease activity state associated with fewer incident vertebral fractures in Mestizo women with systemic lupus erythematosus

Low disease activity state associated with fewer incident vertebral fractures in Mestizo women with systemic lupus erythematosus

Mycophenolic Acid Exposure Optimization Based on Vitamin D Status in Children with Systemic Lupus Erythematosus: A Single-Center Retrospective Study

The Relationship Between Systemic Lupus Erythematosus and Osteoporosis Based on Different Ethnic Groups: a Two-Sample Mendelian Randomization Analysis

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