Article Figures & Data
Figures
- Figure 1.
Percentage changes of bone mineral density over followup period in subgroups of patients according to use of glucocorticoid (GC) during followup (GC+: user, GC−: non-user) and disease flare during followup (panel A, flare+: patients with flare, flare−: patients with no flare), and use of antiosteoporosis therapies (AOT) for ≥ 24 months (panel B, AOT+: user, AOT−: non-user). Bars represent mean percentage change over followup period and error bars represent the standard error of mean. Grey bars: users of GC with disease flare/use of AOT; white bars: nonusers of GC with disease flare/use of AOT; dotted bars: users of GC without disease flare/use of AOT; striped bars: nonusers of GC without disease flare/use of AOT. All p values were derived from between-group comparisons by ANOVA with Bonferroni adjustment.
Tables
Variables Participants, n = 125 Age, yrs 46.5 ± 10.1 Body height, m 1.56 ± 0.06 Body weight, kg 53.7 ± 9.0 Body mass index, kg/m2 22.1 ± 3.5 Postmenopausal, no. (%) 79 (63.2) Age of menopause, yrs 45 (41, 49) Duration of menopause, yrs 5.7 (2.2, 9.8) Current drinker, no. (%) 0 Current smoker, no. (%) 2 (1.6) History of fragility fracture, no. (%) 6 (4.8) Disease duration, yrs 10.4 (5.4, 16.0) SELENA-SLEDAI score 1 (0, 3.5) SDI score 1 (0, 1) Lupus nephritis, no. (%) 76 (61.3) 25[OH]D, μg/l 17.9 (14.2, 21.3) Baseline BMD, g/cm2 Femoral neck 0.668 ± 0.105 Total hip 0.802 ± 0.128 Lumbar spine 0.866 ± 0.149 -
Results are mean ± SD or median (interquartile range) unless otherwise indicated. SELENA-SLEDAI: the Safety of Estrogens in Lupus Erythematosus, National Assessment version of the SLE Disease Activity Index; SDI: the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index; 25[OH]D: 25-hydroxy Vitamin D; BMD: bone mineral density.
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Variables All Patients, n = 125 Hydroxychloroquine, ≥ 3 mos Current user 55 (44.0) Ever user 14 (11.2) Other immunosuppressants*, ≥ 3 mos Current user 29 (23.2) Ever user 17 (13.6) Oral glucocorticoids ≥ 3 mos Current user 86 (68.8) Ever user 7 (5.6) User of ≥ 7.5 mg for ≥ 3 mos 52 (41.6) Cumulative dose#, g 9.6 ± 4.3 Cumulative duration of use#, mos 55.2 ± 10.3 Intravenous methylprednisolone Ever user 6 (4.8) Antiosteoporosis therapies Bisphosphonates Current user 17 (13.6) Ever user 19 (15.2) Use for ≥ 24 mos 20 (16) Hormone replacement therapy, ≥ 24 mos Current user 1 (0.8) Ever user 1 (0.8) Calcium supplement Current user 89 (71.2) Ever user 10 (8) Vitamin D supplement Current user 78 (62.4) Ever user 8 (6.4) Variables Baseline Femoral Neck Followup p Baseline Total Hip Followup p Baseline Lumbar Spine Followup p BMD, g/cm2 0.668 ± 0.105 0.652 ± 0.109 < 0.0001* 0.802 ± 0.128 0.790 ± 0.131 < 0.0005* 0.866 ± 0.149 0.858 ± 0.148 0.128 T score −1.08 ± 1.16 −1.25 ± 1.19 < 0.0001* −0.79 ± 1.19 −0.91 ± 1.22 < 0.0005* −1.15 ± 1.41 −1.22 ± 1.40 0.183 Low bone mass 57 (46.3) 66 (54.1) 0.078 44 (35.2) 52 (41.6) 0.064 48 (38.4) 53 (42.4) 0.383 Osteoporosis 10 (8.1) 14 (11.5) 0.219 10 (8) 9 (7.2) 1.000 19 (15.2) 18 (14.4) 1.000 -
Results are mean ± SD or n (%).
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↵* Statistically significant. BMD: bone mineral density.
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- Table 4.
Percentage changes of bone mineral density over followup period by menstrual status, disease flare, new organ damage, use of glucocorticoids, hydroxychloroquine, immunosuppressants, and antiosteoporosis therapies.
Variables Femoral Neck Total Hip Lumbar Spine Menstrual status at baseline Postmenopausal, n = 79 −2.31 ± 5.10 −1.40 ± 4.58 −0.55 ± 6.84 Premenopausal, n = 46 −2.57 ± 6.38 −2.00 ± 5.91 −0.74 ± 8.15 p 0.801 0.553 0.893 Transitional menstrual status during followup Yes, n = 16 −5.80 ± 6.13 −5.26 ± 5.23 −5.38 ± 6.06 No, n = 109 −1.89 ± 5.36 −1.08 ± 4.88 0.08 ± 7.24 p 0.009* 0.002* 0.005* Flare during followup Yes, n = 44 −3.48 ± 5.47 −3.44 ± 4.75 −3.10 ± 6.35 No, n = 81 −1.80 ± 5.61 −0.60 ± 5.04 0.72 ± 7.49 p 0.112 0.003* 0.005* New organ damage Yes, n = 41 −4.22 ± 5.35 −3.30 ± 4.83 −1.84 ± 7.09 No, n = 84 −1.55 ± 5.53 −0.84 ± 5.06 −0.03 ± 7.39 p 0.013* 0.012* 0.194 New renal damage New renal damage, n = 10 −8.03 ± 4.02 −6.10 ± 3.90 −5.16 ± 5.00 New other damage, n = 31 −2.91 ± 5.17 −2.34 ± 4.80 −0.77 ± 7.39 p ** 0.031* 0.118 0.293 Hydroxychloroquine Yes, n = 68 −2.29 ± 5.25 −1.88 ± 4.91 −0.44 ± 7.11 No, n = 56 −2.55 ± 6.05 −1.31 ± 5.36 −0.85 ± 7.61 p 0.798 0.540 0.756 Immunosuppressants Yes, n = 46 −2.79 ± 6.55 −2.59 ± 6.06 −1.20 ± 8.32 No, n = 79 −2.18 ± 4.99 −1.06 ± 4.40 −0.29 ± 6.69 p 0.568 0.112 0.503 Oral glucocorticoids Yes, n = 93 −2.73 ± 5.90 −2.13 ± 5.31 −1.47 ± 7.55 No, n = 32 −1.50 ± 4.61 −0.21 ± 4.24 1.83 ± 6.03 p 0.289 0.067 0.027* Daily oral glucocorticoids ≥ 7.5 mg for ≥ 3 mos Yes, n = 52 −3.34 ± 5.51 −3.35 ± 4.75 −2.82 ± 7.09 No, n = 41 −1.93 ± 6.35 −0.54 ± 5.62 0.25 ± 7.86 p 0.265 0.012* 0.051 Antiosteoporosis therapies Yes, n = 22 0.33 ± 5.67 1.93 ± 5.34 4.41 ± 7.51 No, n = 103 −2.97 ± 5.43 −2.37 ± 4.75 −1.70 ± 6.84 p 0.013* < 0.0005* < 0.0005* - Table 5.
Multivariate linear regression analyses with percentage changes of bone mineral density over followup period as dependent variables.
Characteristic β (95% CI) p Femoral neck Transitional menstrual status −0.460 (−1.632, 0.712) 0.439 New organ damage −2.417 (−4.526, −0.308) 0.025* Antiosteoporosis therapies 3.397 (0.797, 5.996) 0.011* Total hip Transitional menstrual status −0.526 (−1.570, 0.517) 0.319 Flare during followup −1.262 (−3.662, 1.138) 0.300 New organ damage −1.667 (−3.607, 0.274) 0.092 Daily oral glucocorticoids ≥ 7.5 mg for ≥ 3 mos −0.614 (−3.406, 2.178) 0.664 Cumulative dose of glucocorticoids −0.073 (−0.286, 0.141) 0.502 Antiosteoporosis therapies 3.729 (1.389, 6.070) 0.002* Lumbar spine Transitional menstrual status −1.808 (−3.259, −0.357) 0.015* 25[OH]D level 0.116 (−0.021, 0.254) 0.097 Flare during followup −1.342 (−4.390, 1.584) 0.385 Oral glucocorticoids −6.307 (−14.197, 1.584) 0.116 Cumulative dose of glucocorticoids −0.432 (−0.887, 0.022) 0.062 Cumulative duration of glucocorticoids 0.150 (−0.010, 0.310) 0.065 Antiosteoporosis therapies 6.048 (2.796, 9.301) < 0.0005* -
↵* Statistically significant. 25[OH]D: 25-hydroxy Vitamin D.
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