Bisphosphonate, Vitamin D Combination Therapy May Prevent Atherosclerosis in SLE

Bisphosphonates and vitamin D may help prevent atherosclerosis in patients with systemic lupus erythematosus.

Combination treatment with bisphosphonates and vitamin D may play a role in the prevention of atherosclerosis in patients with systemic lupus erythematosus (SLE), according to the results of a cross-sectional, single-center, retrospective analysis  published in Arthritis Research & Therapy.

The objective of the current study was to investigate the link between the development of atherosclerosis and the use of anti-osteoporotic therapy. A total of 117 consecutive patients with SLE at the Hokkaido University Hospital in Sapporo, Japan who underwent carotid ultrasonography were analyzed retrospectively with the use of propensity scoring. Researchers noted that 36% were receiving bisphosphonates with vitamin D, 23% were receiving bisphosphonates alone, and 26% were receiving vitamin D alone.

Low bone mineral density was more common and the presence of carotid plaque was less prevalent in participants receiving bisphosphonates with vitamin D compared with the other treatment groups. Based on multivariate analysis, age (odds ratio [OR], 1.57; 95% CI, 1.04-2.48; P =.03) and bisphosphonates plus vitamin D treatment (OR, 0.24; 95% CI, 0.07-0.75; P =.01) were both significantly associated with the development of carotid plaque. In all strata that were divided using the propensity score, carotid plaque was statistically significantly less prevalent in the bisphosphonates plus vitamin D group compared with the other groups (Mantel-Haenszel test, P <.015).

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The investigators concluded that because premature atherosclerosis is one of the major complications reported in patients with SLE, and a biologic link between osteoporosis and atherosclerosis has been suggested, combination therapy with bisphosphonates and vitamin D may prevent the development and progression of atherosclerotic plaques better than the use of either agent alone. Additional large-scale prospective studies are warranted in order to confirm the results of this analysis.

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Ohmura K, Kato M, Watanabe T, et al. Effect of combined treatment with bisphosphonate and vitamin D on atherosclerosis in patients with systemic lupus erythematosus: a propensity score-based analysis.  Arthritis Res Ther. 2018;20(1):72.