Women With SLE Are at Increased Risk for Osteoporosis and Osteoporotic Fractures

Women with systemic lupus erythematosus (SLE) are at increased risk for osteoporosis and osteoporotic fractures, according to study results published in Osteoporosis and Sarcopenia.

Compared with the general population, patients with SLE are at an increased risk for osteoporosis and osteoporotic fractures. Previous studies have reported a 2- and 3-fold increased risk for hip and vertebral fractures, respectively, in patients with SLE.

The objective of the current study was to determine the prevalence and risk factors for osteoporosis in patients with SLE.

The retrospective study cohort included women with SLE, aged 40 years or more, who received treatment at 5 university hospitals between January 2012 and December 2016. Dual-energy x-ray absorptiometry was used to measure bone mineral density (BMD) and a fracture risk assessment tool (FRAX) was used to identify high risk for osteoporotic fractures.

Of 155 women (mean age, 53.7±6.8 years) with SLE, 51 (32.9%) fulfilled the World Health Organization (WHO) criteria for osteoporosis, including 8 of 42 (19.0%) premenopausal women and 43 of 113 (38.1%) postmenopausal women. Osteoporotic fractures were detected in 19 of 127 (15.0%) of patients who underwent x-ray of the spine. Of the total cohort, 25 (16.1%) women were at a high risk for osteoporotic fracture according to FRAX with BMD, and 24 (15.5%) women were at a high risk for osteoporotic fracture according to FRAX without BMD. Osteoporosis treatment was reported in 12 of 25 (48%) women at a high risk for osteoporotic fracture according to FRAX with BMD, in 16 of 24 (66.7%) women at high risk for osteoporotic fracture according to FRAX without BMD, and in 35 of 51 (68.6%) women with osteoporosis according to the WHO criteria.

Multivariate analysis indicated that a cumulative dose of glucocorticoids (odds ratio [OR], 1.1; 95% CI, 1.05-1.15; P <.001) and nephritis (OR, 11.35; 95% CI, 1.09-118.57; P =.04) were associated with a high risk for osteoporotic fracture based on the FRAX with BMD criteria. Low complement levels (OR, 4.38; 95% CI, 1.5-12.81; P =.007), erythrocyte sedimentation rate (OR, 1.04; 95% CI, 1.02-1.07; P =.002), and cumulative dose of glucocorticoids (OR, 1.05, 95% CI, 1.01-1.09, P =.03) were associated with osteoporosis based on the WHO criteria in patients with SLE.

The study had several limitations, including the retrospective design, potential selection bias, and missing data on the presence of osteoporosis fractures in 57 patients.

“This study evaluated the high risk [for] osteoporotic fracture as defined by the FRAX model and the risk [for] osteoporosis based on the WHO criteria in patients with SLE. The [percentage] of patients having high-risk for fractures in the FRAX with BMD and without BMD and WHO criteria were 16.1%, 15.5%, and 32.9%, respectively. Among the patients having high-risk for fractures in the FRAX and the WHO criteria, 48 [% to] 68.6% were taking preventive therapy including bisphosphonates,” the researchers concluded.

Reference

Jung J-Y, Choi ST, Park S-H, et al. Prevalence of osteoporosis in patients with systemic lupus erythematosus: A multicenter comparative study of the World Health Organization and fracture risk assessment tool criteria. Osteoporos Sarcopenia. 2020;6(4):173-178. doi:10.1016/j.afos.2020.11.001