Trabecular and Cortical Bone Loss in Systemic Lupus Erythematosus

Houssiau, Frédéric; Lefèbvre, Chantal; Depresseux, Geneviève; Lambert, Michel; Devogelaer, Jean‐Pierre; Deuxchaisnes, C Nagant de

doi:10.1093/rheumatology/35.3.244

Cited by 67 publications

(57 citation statements)

References 9 publications

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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: 82%

“…2055 (4)(5)(6)10,38). Two previous studies of childhood-onset SLE (12,13) also found lower BMD in the spine and femoral neck of patients compared with controls.…”

Section: Osteopenia In Patients With Childhood-onset Slementioning

confidence: 84%

“…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%

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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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Section: Osteopenia In Patients With Childhood-onset Slesupporting

confidence: 82%

“…2055 (4)(5)(6)10,38). Two previous studies of childhood-onset SLE (12,13) also found lower BMD in the spine and femoral neck of patients compared with controls.…”

Section: Osteopenia In Patients With Childhood-onset Slementioning

confidence: 84%

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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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“…Previous reports have documented an association between the cumulative prednisone dose and decreased bone mineral density in SLE patients (10)(11)(12)(13), and conflicting results in several other studies (14-16) likely relate to patient characteristics, accuracy of prednisone history, and sample size issues. In a recent study, Ramsey-Goldman and colleagues found the duration of corticosteroid use and older age at SLE diagnosis to be independent predictors of time from SLE diagnosis to fracture (17).…”

Section: Discussionmentioning

confidence: 94%

Damage in systemic lupus erythematosus and its association with corticosteroids

Zonana-Nacach

Barr

Magder

et al. 2000

Arthritis & Rheumatism

440

244

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Objective. To evaluate the association between corticosteroid use and organ damage in patients with systemic lupus erythematosus (SLE).Methods. The occurrence and date of organ damage, as measured by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index, were determined for 539 patients enrolled in the Hopkins Lupus Cohort Study. The risk of damage associated with the cumulative prednisone dose, high-dose prednisone (>60 mg/day for >2 months), and pulse methylprednisolone (1,000 mg intravenously for 1-3 days) was estimated using Cox proportional hazards regression analyses, controlling for age, race, and sex. Risk estimates for the cumulative prednisone dose were based on a reference dose of 36.5 gm (e.g., 10 mg of prednisone daily for 10 years [or equivalent]).Results. The cumulative prednisone dose was significantly associated with the development of osteoporotic fractures (relative risk [RR] 2.5, 95% confidence interval [95% CI] 1.7, 3.7), symptomatic coronary artery disease (RR 1.7, 95% CI 1.1, 2.5), and cataracts (RR 1.9, 95% CI 1.4, 2.5). Each intravenous pulse was associated with a small increase in the risk of osteoporotic fractures (RR 1.3, 95% CI 1.0, 1.8); however, this result failed to reach statistical significance (P ‫؍‬ 0.07). Each 2-month exposure to high-dose prednisone was associated with a 1.2-fold increase in the risk of both avascular necrosis (95% CI 1.1, 1.4) and stroke (95% CI 1.0, 1.5).Conclusion. SLE patients receiving long-term prednisone therapy were at significant risk of morbidity due to permanent organ damage. Additional research is required to determine the relative contributions of SLE disease activity and corticosteroids to the pathogenesis of specific types of organ damage. Furthermore, new steroid-sparing therapies are needed in order to treat disease activity and minimize cumulative and high-dose prednisone exposure.

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“…Além disso, a maior parte dos estudos disponíveis são baseados na avaliação densidade mineral óssea (DMO) através da densitometria, um método de custo relativamente baixo e amplamente disponível (12)(13)(14)(15)(16)(17)(18). Entretanto, sabemos que a redução da DMO, apesar de clinicamente relevante, pode não refletir adequamente a resistência óssea e, principalmente, não contribui para a compreensão da fisiopatologia da doença óssea (19,20).…”

Section: Introductionunclassified

Doença óssea em pacientes com nefrite lúpica: aspectos inflamatórios

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Trabecular and Cortical Bone Loss in Systemic Lupus Erythematosus

Cited by 67 publications

References 9 publications

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

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

Damage in systemic lupus erythematosus and its association with corticosteroids

Doença óssea em pacientes com nefrite lúpica: aspectos inflamatórios

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