Bone mineral density and vitamin D status in systemic lupus erythematosus (SLE): A systematic review

Abstract

Despite the improvement in the quality of life of patients with SLE due to scientific and technological advances, SLE remains a disease that over the years may produce irreversible damage to patients. Osteoporosis and secondary bone fractures are two of the major causes of irreparable injury in patients with SLE. Vitamin D insufficiency may play a vital role both in reduced bone mineral density (BMD) and in the appearance of fractures, although its mechanisms of action are still unclear. We performed a systematic review of the literature in order to determine the prevalence and predictors of reduced vitamin D plasma levels, bone loss and the presence of fractures in SLE patients. Our review encompassed all English-language publications using Medline and EMBase electronic databases from their inception (1966 and 1980, respectively) to December 2016. We included all intervention studies and observational studies in which vitamin D plasma levels, BMD and bone loss were measured and applied to patients with SLE. Previous studies suggested an increase in bone loss and fracture in patients with SLE compared with general population and although there is a high prevalence of vitamin D insufficiency in the general population, previous studies had demonstrated lower vitamin D levels in patients with SLE compared to age-matched controls. The etiology of reduced bone mass and reduced vitamin D plasma levels in SLE is multifactorial and includes a variety of intrinsic factors related to the disease itself and treatment side effects. SLE patients are at risk for developing these two comorbidities (reduced vitamin D plasma levels and low BMD) and it is therefore essential to study, monitor, prevent and treat bone metabolism disorders in SLE patients.

Response to: ‘Bone health, an often forgotten comorbidity in systemic lupus erythematosus: a comment on the new recommendations’ by Orsolini et al

“…For patients receiving GC, the recent guidelines of the American College of Rheumatology for the prevention and treatment of GC-induced osteoporosis should be followed. 3 We fully agree with Orsolini et al that a future update of the EULAR recommendations for the management of SLE should include specific guidance regarding bone health.…”

Trabecular Bone Score and Bone Quality in Systemic Lupus Erythematosus Patients

“…There is a multifactorial etiology of bone loss in SLE, which includes systemic inflammation; serological, metabolic, and hormonal factors; and maybe also genetic factors and medication (5)(6)(7)(8). Moreover, a high prevalence of morphometric vertebral fractures was observed in SLE patients, although 1/3 had normal bone density, in line with the multifactorial etiology of fractures in SLE (3)(4)(5).…”

“…Systemic lupus erythematosus (SLE) is one of the most complex multisystemic autoimmune diseases as it encompasses a wide spectrum of clinical and serological manifestations ( 1 , 2 ). Recent studies demonstrate a higher incidence of osteoporosis (OP) and fractures in SLE patients than in healthy subjects (HS) ( 3 – 5 ). There is a multifactorial etiology of bone loss in SLE, which includes systemic inflammation; serological, metabolic, and hormonal factors; and maybe also genetic factors and medication ( 5 – 8 ).…”

Effect of vitamin D on serum markers of bone turnover in SLE in a randomised controlled trial

“…Systemic inflammation, glucocorticoid use, lupus nephritis, premature menopause and vitamin D deficiency all have deleterious effects on bone health. Numerous studies have demonstrated that lower vitamin D levels are associated with higher SLE disease activity, although trials of vitamin D supplementation for reducing SLE disease activity have had conflicting results 4–7. Data on vitamin D supplementation for bone health in SLE are mostly derived from observational studies, raising concerns about confounding by indication; patients with SLE perceived to be at highest risk for fracture may be more likely to receive vitamin D.…”