Prevalence and predictors of low bone density and fragility fractures in women with systemic lupus erythematosus in a Mediterranean region

Abstract

Studies have found an increase in bone loss and fracture in individuals with systemic lupus erythematosus (SLE) compared with general population. The aim of this study was to describe the prevalence of osteopenia, osteoporosis, and fragility fractures and to find potential predictors of bone loss in our cohort of SLE patients. We performed a cross-sectional study and collected 67 bone density measurements (BMD) of our SLE patients. We also collected sociodemographic data, 25-OH-vitamin D levels, serological markers, activity index, SLE cumulative damage index, and pharmacologic treatment. Sixty-seven consecutive BMD from SLE patients were assessed. Osteopenia was found in 28-46% of SLE patients. Osteoporosis ranged from 3 to 6%[corrected]. The only statistically significant correlation we found was between weight and height with total hip and femoral neck BMD (p < 0.05). The most frequent BMD-affected site was at the femoral neck, showing osteopenia in 40.3% [corrected] of SLE patients. Osteoporosis was found in up to 6% [corrected] of SLE patients. We found no predictors of bone loss in relation to the disease activity or its treatment. Fragility fractures were seen in 4.4% of SLE patients. All patients with fragility fractures showed osteopenia at BMD. There is a high prevalence of bone loss in SLE patients, since up to 40% [corrected] of SLE patients showed low BMD. Total hip and femoral neck osteopenia were the most frequent findings correlated with low BMI. We found a lower prevalence of fragility fractures compared with other series.

Frequency of Low Bone Mineral Density and Osteoporosis in a Cohort of Egyptian Patients with Systemic Lupus Erythematosus

“…Barbulescu and his coworkers in (2015) demonstrated that prevalence of osteoporosis among studied SLE patients was 36% and osteopenia 40% (20) . Franco et al (21) stated that 50 % of patients had osteopenia and 31 % of their patients had osteoporosis Other authors reported prevalence of osteoporosis was varying from 25 to 74 %, these wide variations between different studies would be related to differences in study design, sex, age, ethnicity, disease severity and treatment (6) .…”

“…Older age, postmenopausal status, smoking, disease duration, glucocorticoid (GC) treatment, renal insufficiency, Raynauds syndrome, lupus anticoagulant and reduced BMD have all been reported as risk factors of osteoporosis and fractures in SLE (7) .SLE itself may result in low BMD, especially in patients with high systemic lupus erythematosus disease activity index (SLEDAI) (8) . However, some recent studies have shown that there are no predictors of bone loss in relation to the disease activity (6) .…”

“…Recent studies have highlighted the high prevalence of osteoporosis and bone fractures in a relatively young population of patients suffering from SLE (5) .The etiology of reduced bone mass in SLE is multifactorial and includes a variety of intrinsic factors to the disease itself and treatments side effects (6) . Older age, postmenopausal status, smoking, disease duration, glucocorticoid (GC) treatment, renal insufficiency, Raynauds syndrome, lupus anticoagulant and reduced BMD have all been reported as risk factors of osteoporosis and fractures in SLE (7) .SLE itself may result in low BMD, especially in patients with high systemic lupus erythematosus disease activity index (SLEDAI) (8) .…”

Limitations of Standard Immunosuppressive Treatment in ANCA-Associated Vasculitis and Lupus Nephritis

“…Recent studies confirm the presence of osteopenia in 28-46% and osteoporosis in 3-9% of SLE patients with fragility fractures in 4.4% of patients [59]. In a Johns Hopkins cohort of 539 patients with SLE, the cumulative dose of prednisone was significantly associated with the development of osteoporotic fractures (RR = 2.5) [54] and each 2-month exposure to high-dose prednisone led to 1.2-fold increase in the avascular bone necrosis.…”

Safety of belimumab in association with denosumab in a patient affected by Lupus Erythematosus: a case report

“…The occurrence of osteopenia, osteoporosis (OP), and fragility fractures (FFx) in SLE patients has been widely described in literature [8][9][10][11][12][13]. Osteopenia and osteoporosis are reported in 25-74% and in 1.4-68% of SLE patients, respectively, and the occurrence of symptomatic fractures is increased 5-fold in women with SLE [14].…”