Vitamin D insufficiency in a large female SLE cohort

Abstract

The objective of this study was to determine the vitamin D status and its relationship with disease and therapy features and with bone mineral density in women with systemic lupus erythematosus. Non-pregnant systemic lupus erythematosus women with dual-energy X-ray absorptiometry and vitamin D measurements performed between May 1 2005 and August 31 2006 were studied. In each patient, the lowest T-score of the first dual-energy X-ray absorptiometry scan during the study period was used. In postmenopausal women, a T-score > or = 1.0 standard deviation was considered normal, between -1.0 and -2.5 standard deviations osteopenia and < or = 2.5 standard deviations osteoporosis; in premenopausal women a T-score > or = 2.5 standard deviations was normal and < or = 2.5 standard deviations defined as reduced bone density. 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels were determined at the time of dual-energy X-ray absorptiometry. A 25-hydroxyvitamin D level of <80 nmol/L was defined as sub-optimal and a level <40 nmol/L as deficient. Demographic and clinical variables were investigated for association with vitamin D levels by univariate and multivariate analyses. One-hundred and twenty-four systemic lupus erythematosus women had dual-energy X-ray absorptiometry scans and vitamin D assays performed during the study period. Sub-optimal 25-hydroxyvitamin D levels were found in 82 (66.7%) and deficient 25-hydroxyvitamin D levels in 22 (17.9%) patients. The disease-related features examined at the time of vitamin D assays or bone mineral density showed no correlation with vitamin D levels by univariate analyses. Neither 25-hydroxyvitamin D nor 1,25-dihydroxyvitamin D was associated with bone mineral density status among these patients. A multivariate logistic regression model identified season, cumulative glucocorticoid exposure, and serum creatinine as being associated with 25-hydroxyvitamin D levels, whereas ethnicity, glucocorticoid exposure, and serum creatinine were associated with 1,25-dihydroxyvitamin D levels. In conclusion, sub-optimal vitamin D status is common in women with systemic lupus erythematosus and is related to season, cumulative glucocorticoid dose, and serum creatinine.

Osteoporosis and fractures in systemic lupus erythematosus

“…Recently, an association between high serum creatinine and low 1,25(OH) 2 D levels in SLE patients was reported (30).…”

Low Serum Vitamin D Levels in Egyptian Adults With Chronic Primary Immune Thrombocytopenia: A Single Center Study.

“…This finding may indicate that vitamin D deficiency in our patients was not due to steroid therapy itself. However, Toloza et al [38] found that cumulative corticosteroid exposure in SLE patients was associated with low vitamin D levels.…”

An evaluation of vitamin D status in individuals with systemic lupus erythematosus

“…Some have reported an association between vitamin D status and disease activity with lower vitamin D status contributing to greater disease activity (17)(18)(19)(20)(22)(23)(24)(25) . An association between vitamin D and fatigue has also been reported (16,26) ; however, not all studies have observed a relationship between vitamin D and indices of disease activity in SLE (27)(28)(29)(30) . Therefore, currently there is no clear consensus regarding the role of vitamin D in the progression and/or management of SLE.…”

“…Research in Saudi populations previously used cut-offs in the range of 25-50 nmol/l to denote sufficient vitamin D status; however, more recently a threshold of 75 nmol/l is considered to represent vitamin D sufficiency (39) . The levels of adequate vitamin D status in these two studies (19,20) (17,18,25,28,33) . Two studies report serum 25(OH)D concentrations in the range of 75-80 nmol/l as deficient vitamin D status (12,26) .…”