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Bone health and systemic lupus erythematosus

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Abstract

Osteoporosis is a potentially preventable condition frequently encountered in patients with systemic lupus erythematosus (SLE). Bone loss in SLE is likely a multi-factorial process involving traditional osteoporosis risk factors along with lupus-related factors. Recognizing potential contributors to bone loss in patients with SLE may allow earlier detection of osteoporosis, optimize bone health, and minimize future fracture risk. This paper discusses recent epidemiologic information related to osteoporosis and fractures in SLE, and highlights relevant developments regarding evaluation and treatment of patients at risk for bone loss.

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References and Recommended Reading

  1. Yee CS, Crabtree N, Skan J, et al.: Prevalence and predictors of fragility fractures in systemic lupus erythematosus. Ann Rheum Dis 2005, 64:111–113. One of the largest studies to ascertain fracture prevalence and associated predictors in 242 patients with SLE. Reduced BMD and age were signifi-cantly associated with fragility fractures since diagnosis of SLE, whereas corticosteroid exposure was not a significant factor.

    Article  PubMed  Google Scholar 

  2. Redlich K, Ziegler S, Kiener HP, et al.: Bone mineral density and biochemical parameters of bone metabolism in female patients with systemic lupus erythematosus. Ann Rheum Dis 2000, 59:308–310.

    Article  PubMed  CAS  Google Scholar 

  3. Kalla AA, Fataar AB, Jessop SJ, Bewerunge L: Loss of trabecular bone mineral density in systemic lupus erythematosus. Arthritis Rheum 1993, 36:1726–1734.

    Article  PubMed  CAS  Google Scholar 

  4. Sinigaglia L, Varenna M, Binelli L, et al.: Determinants of bone mass in systemic lupus erythematosus: a cross sectional study on premenopausal women. J Rheumatol 1999, 26:1280–1284. The study assessed determinants of bone mass in 84 premenopausal women with SLE and found 22.6% of patients to have osteoporosis. Patients with osteoporosis had greater disease damage and longer disease duration, but also had higher cumulative corticosteroid intake and longer corticosteroid use.

    PubMed  CAS  Google Scholar 

  5. Pineau CA, Urowitz MB, Fortin PJ, et al.: Osteoporosis in systemic lupus erythematosus: factors associated with referral for bone mineral density studies, prevalence of osteoporosis and factors associated with reduced bone density. Lupus 2004, 13:436–441. In 205 women with SLE, increased damage and age were associated with low BMD. However, disease activity and corticosteroid use were not associated with osteoporosis.

    Article  PubMed  CAS  Google Scholar 

  6. Teichmann J, Lange U, Stracke H, et al.: Bone metabolism and bone mineral density of systemic lupus erythematosus at the time of diagnosis. Rheumatol Int 1999, 18:137–140.

    Article  PubMed  CAS  Google Scholar 

  7. Gilboe I, Kvien TK, Haugeberg G, Husby G: Bone mineral density in systemic lupus erythematosus: comparison with rheumatoid arthritis and healthy controls. Ann Rheum Dis 2000, 59:110–115.

    Article  PubMed  CAS  Google Scholar 

  8. Kipen Y, Briganti E, Strauss B, et al.: Three year followup of bone mineral density change in premenopausal women with systemic lupus erythematosus. J Rheumatol 1999, 26:310–317. Study provides the longest follow-up data on BMD change for pre-menopausal women with SLE. Results indicate only minimal changes in lumbar spine and femoral neck BMD for 32 women, and physical activity was found to be protective for reduction in femoral neck BMD.

    PubMed  CAS  Google Scholar 

  9. Jardinet D, Lefebvre C, Depresseux G, et al.: Longitudinal analysis of bone mineral density in pre-menopausal female systemic lupus erythematosus patients: deleterious role of glucocorticoid therapy at the lumbar spine. Rheumatology (Oxford) 2000, 39:389–392.

    Article  CAS  Google Scholar 

  10. Boyanov M, Robeva R, Popivanov P: Bone mineral density changes in women with systemic lupus erythematosus. Clin Rheumatol 2003, 22:318–323.

    Article  PubMed  CAS  Google Scholar 

  11. Ramsey-Goldman R, Dunn JE, Huang CF, et al.: Frequency of fractures in women with systemic lupus erythematosus: comparison with United States population data. Arthritis Rheum 1999, 42:882–890. Reports fracture frequency on 702 women with SLE and compares fracture occurrence in SLE patients with general US population data from the 1994 National Health Interview Survey. Fracture occurrence in women having SLE was five-fold greater than women from the gen-eral population, and older age at SLE diagnosis and longer duration of corticosteroid use were associated with fracture occurrence.

    Article  PubMed  CAS  Google Scholar 

  12. Bultink IE, Lems WF, Kostense PJ, et al.: Prevalence of and risk factors for low bone mineral density and vertebral fractures in patients with systemic lupus erythematosus. Arthritis Rheum 2005, 52:2044–2050. The study exclusively assessed prevalent vertebral fractures at the thoracic and lumbar spine via review of radiographs. At least one vertebral fracture was found in 20% of patients having SLE, and low bone mineral density, postmenopausal status, and vitamin D defi-ciency were identified as associated risk factors for vertebral fractures.

    Article  PubMed  Google Scholar 

  13. Bone Health and Osteoporosis: A Report of the Surgeon General. http://www.surgeongeneral.gov/library/bonehealth/ docs/full_report.pdf Accessed August 1, 2005. The report provides the first ever comprehensive overview on current scientific evidence related to prevention, assessment, diagnosis, and treatment of bone disease issued by the Surgeon General.

  14. Bhattoa HP, Kiss E, Bettembuk P, Balogh A: Bone mineral density, biochemical markers of bone turnover, and hor-monal status in men with systemic lupus erythematosus. Rheumatol Int 2001, 21:197–102.

    Article  Google Scholar 

  15. Di Munno O, Mazzantini M, Delle Sedie A, et al.: Risk factors for osteoporosis in female patients with systemic lupus erythematosus. Lupus 2004, 13:724–730.

    Article  Google Scholar 

  16. Wawrzynska L, Tomkowski WZ, Przedlacki J, et al.: Changes in bone density during long-term administration of low-molecular-weight heparins or acenocoumarol for secondary prophylaxis of venous thromboembolism. Pathophysiol Haemost Thromb 2003, 33:64–67.

    PubMed  CAS  Google Scholar 

  17. Sen D, Keen RW: Osteoporosis in systemic lupus erythemato-sus: prevention and treatment. Lupus 2001, 10:227–232.

    Article  PubMed  CAS  Google Scholar 

  18. Schapira D, Kabala A, Raz B, Israeli E: Osteoporosis in murine systemic lupus erythematosus-a laboratory model. Lupus 2001, 10:431–438.

    Article  PubMed  CAS  Google Scholar 

  19. Kipen Y, Strauss BJ, Morand EF: Body composition in systemic lupus erythematosus. Br J Rheumatol 1998, 37:514–519.

    Article  PubMed  CAS  Google Scholar 

  20. Becker A, Fischer R, Scherbaum WA, Schneider M: Osteoporo-sis screening in systemic lupus erythematosus: impact of disease duration and organ damage. Lupus 2001, 10:809–814.

    Article  PubMed  CAS  Google Scholar 

  21. Gravallese E M: Bone destruction in arthritis. Ann Rheum Dis 2002, 61(Suppl 2):ii84–86.

    PubMed  Google Scholar 

  22. Cummings SR, Bates D, Black DM: Clinical use of bone densitometry: scientific review. JAMA 2002, 288:1889–1897. vides an evidence-based review of available techniques for assess-ing bone mass, recent recommendations on when to measure bone mass and guidance on clinical application of bone densitometry results in making therapeutic decisions

    Article  PubMed  Google Scholar 

  23. Raisz LG: Clinical practice. Screening for osteoporosis. N Engl J Med 2005, 353:164–171. oncise review of current screening recommendations in selecting patients for bone densitometry and highlights important aspects of interpreting dual-energy x-ray absorptiometry results

    Article  PubMed  CAS  Google Scholar 

  24. National Osteoporosis Foundation: Physician’s guide to prevention and treatment of osteoporosis. http://www.nof.org/professionals/clinical.htm Accessed August 1, 2005.

  25. Lee C, Ramsey-Goldman R: Osteoporosis in systemic lupus erythematosus mechanisms. Rheum Dis Clin North Am 2005, 31:363–385.

    Article  PubMed  Google Scholar 

  26. Sanchez-Guerrero J, Karlson EW, Liang MH, et al.: Past use of oral contraceptives and the risk of developing systemic lupus erythematosus. Arthritis Rheum 1997, 40:804–808.

    Article  PubMed  CAS  Google Scholar 

  27. Cooper GS, Dooley MA, Treadwell EL, et al.: Hormonal and reproductive risk factors for development of systemic lupus erythematosus: results of a population-based, case-control study. Arthritis Rheum 2002, 46:1830–1839. opulation-based, case-control study of 240 women with SLE found minimal evidence for increased risk of SLE in women exposed to hormone therapy or oral contraceptives

    Article  PubMed  CAS  Google Scholar 

  28. Kung AW, Chan TM, Lau CS, et al.: Osteopenia in young hypogonadal women with systemic lupus erythematosus receiving chronic steroid therapy: a randomized controlled trial comparing calcitriol and hormonal replacement therapy. Rheumatology (Oxford) 1999, 38:1239–1244.

    Article  CAS  Google Scholar 

  29. Bhattoa HP, Bettembuk P, Balogh A, et al.: The effect of 1-year transdermal estrogen replacement therapy on bone mineral density and biochemical markers of bone turnover in osteopenic postmenopausal systemic lupus erythematosus patients: a randomized, double-blind, placebo-controlled trial. Osteoporos Int 2004, 15:396–404.

    Article  PubMed  CAS  Google Scholar 

  30. Buyon JP, Petri MA, Kim MY, et al.: The effect of combined estrogen and progesterone hormone replacement therapy on disease activity in systemic lupus erythematosus: a randomized trial. Ann Intern Med 2005, 21:953–962. 2-month, randomized, double-blind, placebo-controlled trial of 351 menopausal women with inactive or stable SLE treated with hormone therapy showed no significant differences in severe SLE flares between treatment groups, and only a modest increased risk for generally mild-to-moderate SLE flares in the HT treated group

    Google Scholar 

  31. Mease PJ, Ginzler EM, Gluck OS, et al.: Effects of prasterone on bone mineral density in women with systemic lupus erythematosus receiving chronic glucocorticoid therapy. J Rheumatol 2005, 32:616–621.

    PubMed  CAS  Google Scholar 

  32. Rossouw JE, Anderson GL, Prentice RL, et al.: ting Group for the Women’s Health Initiative Investigators Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA 2002, 288:321–333.

    Article  PubMed  CAS  Google Scholar 

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Lee, C., Ramsey-Goldman, R. Bone health and systemic lupus erythematosus. Curr Rheumatol Rep 7, 482–489 (2005). https://doi.org/10.1007/s11926-005-0056-1

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