The Effect of Systemic Lupus Erythematosus and Long-Term Steroid Therapy on Bone Mass in Pre-Menopausal Women

Pons, Françesca; Peris, Pilar; Guañabens, Núria; Font, José A.; Huguet, Marina; Espinosa, Gaudêncio; Ingelmo, M; Múñoz-Gómez, J; Setoain, J

doi:10.1093/rheumatology/34.8.742

Cited by 81 publications

(49 citation statements)

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“…Steroids are a mainstay drug therapy in JDM and are a well-recognized cause of osteoporosis in other rheumatic diseases (17)(18)(19)(20)(21)(22)(23). Differently from other reports, our study showed that in children with JDM there is no significant correlation between bone mass and steroid use, a fact possibly due to the small number of patients included in our study.…”

Section: Discussioncontrasting

confidence: 99%

Bone mineral density of Brazilian girls with juvenile dermatomyositis

Castro

Terreri

Szejnfeld

et al. 2005

Braz J Med Biol Res

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We measured bone mineral density (BMD) in girls with juvenile dermatomyositis (JDM) considering multiple factors in order to determine if it could be used as a predictor of reduction in bone mass. A cross-sectional study of lumbar spine BMD (L2-L4) was conducted on 10 girls aged 7-16 years with JDM. A group of 20 age-matched healthy girls was used as control. Lumbar spine BMD was measured by dualenergy X-ray absorptiometry. Weight, height and pubertal Tanner stage were determined in all patients and controls. Duration of disease and mean daily and cumulative steroid doses were calculated for all patients on the basis of their medical charts. JDM activity was determined on the basis of the presence of muscle weakness, cutaneous vasculitis and/or elevation of serum concentration of one or more skeletal muscle enzymes. Seven patients demonstrated osteopenia or osteoporosis. Lumbar BMD was significantly lower in the JDM patients than the age-matched healthy control girls (0.712 vs 0.878, respectively; Student t-test, P = 0.041). No significant correlation between BMD and age, height, Tanner stage, disease duration, corticosteroid use, or disease activity was observed in JDM girls, but a correlation was observed between BMD and weight (Pearson's correlation coefficient, r = 0.802). Patients with JDM may be at risk for a significant reduction in BMD that might contribute to further skeletal fragility. Our results suggest that reduced bone mass in JDM may be related to other intrinsic mechanisms in addition to steroid treatment and some aspects of the disease itself may contribute to this condition.

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Section: Discussioncontrasting

confidence: 99%

Bone mineral density of Brazilian girls with juvenile dermatomyositis

Castro

Terreri

Szejnfeld

et al. 2005

Braz J Med Biol Res

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“…After adjustment for cumulative dose and other variables, daily dose was not associated with BMD at any of those sites. Similar to the reports on cumulative dose, daily CS dose was found to be a predictor of BMD in some [15,35,[103][104] but not in other studies [14,[22][23][24]29,37,43,46,59,65,66,101].…”

Section: Relationship To Cs Dosesupporting

confidence: 82%

The Epidemiology of Corticosteroid-Induced Osteoporosis: a Meta-analysis

Staa

Leufkens

Cooper

2002

Osteoporosis International

1,038

272

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Abstract. Studies of oral corticosteroid dose and loss of bone mineral density have reported inconsistent results. In this meta-analysis, we used information from 66 papers on bone density and 23 papers on fractures to examine the effects of oral corticosteroids on bone mineral density and risk of fracture. Strong correlations were found between cumulative dose and loss of bone mineral density and between daily dose and risk of fracture. The risk of fracture was found to increase rapidly after the start of oral corticosteroid therapy (within 3 to 6 months) and decrease after stopping therapy. The risk remained independent of underlying disease, age and gender. We conclude that oral corticosteroid treatment using more than 5 mg (of prednisolone or equivalent) daily leads to a reduction in bone mineral density and a rapid increase in the risk of fracture during the treatment period. Early use of preventive measures against corticosteroid-induced osteoporosis is recommended.

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“…The cumulative dose of corticosteroids was found to be an important variable in explaining decreased bone mass in the femoral neck and lumbar spine. These findings are consistent with those of several studies in adult-onset SLE (6,(8)(9)(10) and contradict the results of other studies (4,38). Trapani et al also reported an association between the cumulative steroid dose and BMD in patients with childhood-onset SLE (13), whereas Castro et al did not observe such an association (12).…”

Section: Osteopenia In Patients With Childhood-onset Slesupporting

confidence: 81%

“…through decreased formation and increased resorption of bone (21,22), but the impact of corticosteroids on bone loss in the setting of SLE is unclear (6,9,10,19).…”

mentioning

confidence: 99%

Frequency of osteopenia in children and young adults with childhood‐onset systemic lupus erythematosus

Lilleby¹,

Lien²,

Frøslie³

et al. 2005

Arthritis & Rheumatism

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Objective. To determine the frequency of osteopenia in patients with childhood-onset systemic lupus erythematosus (SLE) compared with that in healthy matched controls, and to evaluate the relationship between disease-related variables and bone mineral mass.Methods. Bone mineral density (BMD) and bone mineral content (BMC) were measured in a cohort of 70 patients with childhood-onset SLE (mean ؎ SD disease duration 10.8 ؎ 8.3 years, mean ؎ SD age 26.4 ؎ 9.9 years) and 70 age-and sex-matched healthy controls. BMD and BMC of the femoral neck, lumbar spine, total body, and distal one-third of the radius were measured by dual x-ray absorptiometry. We investigated the relationship between BMC and the following disease variables: cumulative dose of corticosteroids, organ damage, current use of corticosteroids, use of cyclophosphamide, age at disease onset, and disease activity at the time of diagnosis. Biochemical markers of bone metabolism were also measured.Results. BMD values for the lumbar spine and femoral neck were significantly lower in patients than in healthy controls. The reduction in BMD of the lumbar spine was significantly greater than that of the total body. In multiple linear regression analyses, a higher cumulative corticosteroid dose was significantly associated with lower BMC of the lumbar spine and femoral neck. Decreased lumbar spine BMC was also related to male sex.Conclusion. The frequency of osteopenia was higher in patients with childhood-onset SLE than in matched controls. The lumbar spine was the most seriously affected skeletal site, followed by the femoral neck. The cumulative dose of corticosteroids was shown to be an important explanatory variable for BMC values in the lumbar spine and femoral neck.

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The Effect of Systemic Lupus Erythematosus and Long-Term Steroid Therapy on Bone Mass in Pre-Menopausal Women

Cited by 81 publications

References 0 publications

Bone mineral density of Brazilian girls with juvenile dermatomyositis

Bone mineral density of Brazilian girls with juvenile dermatomyositis

The Epidemiology of Corticosteroid-Induced Osteoporosis: a Meta-analysis

Frequency of osteopenia in children and young adults with childhood‐onset systemic lupus erythematosus

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