Risk factors for osteoporosis in female patients with systemic lupus erythematosus

Abstract

In the last years it has been recognized that patients with systemic lupus erythematosus (SLE) are at high risk of osteoporosis (OP) and fractures, both occurring through disease-specific (chronic arthritis, reduced physical activity, induction of cytokines promoting bone resorption, renal impairment, endocrine factors) and nondisease-specific mechanisms (sunshine avoidance with consequent vitamin D deficiency, glucocorticoids, immunosuppressants and chronic anticoagulants). Regarding anticoagulants, subcutaneous heparin is crucial against the risk of recurrent thromboembolism or pregnancy loss, specifically in patients with SLE and anti-phospholipid syndrome (APS). Thus heparin-induced OP represents one of the hazards of this treatment, first because heparin must be used long-term and secondly because pregnancy and lactation themselves may predispose to OP and fractures. Current data suggest the use of prophylaxis with calcium and vitamin D in all patients treated with heparin during pregnancy. Nevertheless glucocorticoid-induced OP (GIOP) is considered the most serious risk factor for OP and fractures in SLE patients. All guidelines recommend general measures and supplementation with calcium and vitamin D in all patients. However when considering premenopausal patients, there is no generally recommended treatment. Bisphosphonates, which are considered the first choice therapy for the prevention and treatment of GIOP, should be used 'cautiously' in these patients. Therefore the potential risks and lack of efficacy data on fracture risk reduction in premenopausal patients must be weighed against their proven efficacy in postmenopausal patients.

Initially elevated osteoprotegerin serum levels may predict a perioperative myocardial lesion in patients undergoing coronary artery bypass grafting

“…Although some evidence is found in the literature concerning a potential mechanism for pharmacologically induced elevation of OPG with the chronic use of antibiotics, little is known about the possible effects of single doses, as were used for our patients (31). During surgery patients were anticoagulated with sodium heparin, which could be a potential basis for our findings, because it is well-known that heparin induces osteoporosis with long-term use (32). However, again, it remains unclear whether it has an impact on OPG in 24-hr follow-up.…”

Bone health and systemic lupus erythematosus

“…In addition to corticosteroids, other therapies often employed in clinically managing SLE may also promote bone loss [15]. Therapies that result in bone loss in SLE may do so indirectly.…”

“…In their study group, which consisted of mostly white, pre-menopausal women, the prevalence of osteopenia and osteoporosis from results of BMD measurements was 39% and 4%, respectively. Based on radiographic findings of vertebral deformities, at least one vertebral fracture was identified in 20% (95% CI, [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] of patients with 89% of fractures localized to the thoracic spine and 11% found in the lumbar spine. Vertebral fractures were associated with over use of intravenous methylprednisone and male gender.…”

Osteoporose e gravidez

“…corticosteróides, é possível que haja incremento na perda mineral óssea dessas pacientes, caso engravidem. Adicionalmente, ressaltamos, nas pacientes portadoras de síndrome do anticorpo antifosfolípide, primária ou associada ao lúpus eritematoso sistêmico, o risco adicional, por vezes esquecido, do uso crônico de heparina no surgimento de osteoporose (14) .…”