SLE and osteoporosis: dependence and/or independence on glucocorticoids

F, Sels; Dequeker, Jan; Verwilghen, J; Jm, Mbuyi-Muamba

doi:10.1177/096120339600500202

Cited by 34 publications

(16 citation statements)

References 16 publications

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“…To our knowledge, only a few studies have investigated the effect of oral corticosteroids on BMD in SLE, with discordant results [2,9,10,12,17]. Dykman, in a study on BMD in 33 patients with SLE, demonstrated that cumulative dosage of prednisone (over 30 mg) was the most important factor determining corticosteroid osteopenia [2].…”

Section: Discussionmentioning

confidence: 90%

“…Formiga et al found a significantly reduced BMD in 74 female SLE patients, but was not able to demonstrate any association between BMD and cumulative or baseline doses of corticosteroids [12]. Sels et al analyzed all the SLE patients (61 cases) reported in the literature, who had never received corticosteroid treatment; he found a modest loss of BMD at spine, hip and forearm, suggesting that osteopenia might be disease-related [17]. All these studies, however, were performed on adults and gave no prospective evaluation of mineralization during steroid therapy.…”

Section: Discussionmentioning

confidence: 95%

“…In SLE, steroids have been shown to increase the tendency to develop osteoporosis; the rate of bone loss has been correlated to daily corticosteroid dose, to the duration of treatment, and to the cumulative dose [2, 14 -16]. In contrast, other studies support the independence of osteoporosis in SLE from glucocorticoids [9,12,17,18]. Moreover, steroid-induced osteoporosis is still poorly studied in paediatric rheumatic diseases, in particular in JRA [19 -21].…”

Section: Introductionmentioning

confidence: 95%

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Osteoporosis in juvenile systemic lupus erythematosus: a longitudinal study on the effect of steroids on bone mineral density

Trapani

Civinini

Ermini

et al. 1998

Rheumatology International

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Peak bone mass is an important determinant of future bone mass and of the risk of osteoporosis and subsequent fractures. Although some information concerning bone mineral density (BMD) in adults affected with systemic lupus erythematosus (SLE) is available, few data on children and adolescents have been reported. Many variables, such as duration and activity of the disease, reduced sun exposure, and steroid therapy have been suggested as risk factors in the pathogenesis of osteoporosis in SLE. In this study, we longitudinally evaluated, by dual energy X-ray absorptiometry (DEXA), the BMD of 20 young patients affected with juvenile SLE (JSLE), in order to establish the degree of osteoporosis and the influence of steroid treatment, among other clinical variables. At baseline, the mean BMD in JSLE patients was 0.978 g/cm2 and in controls 1.038 g/cm2 (P = 0.31). At 1 year (time 2), this value became 0.947 g/cm2 in JSLE children; the mean individual difference was 0.28 g/cm2 (3.4%). Only in those patients aged 19-25 years BMD was significantly lower than in controls, both at baseline and at time 2. Considering the steroid treatment, no significant difference between the two groups was found either at baseline or at time 2; however, the mean yearly BMD loss in the steroid patients was 0.031 g/cm2 (3.5%) vs. 0.005 g/cm2 (0.5%) in those who had not taken steroids. A significantly inverse correlation between BMD and the cumulative dosage of corticosteroids has been detected. BMD produced a significantly inverse correlation to the cumulative dosage of corticosteroids; no significant correlation has been found between BMD and disease activity or duration.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 95%

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Osteoporosis in juvenile systemic lupus erythematosus: a longitudinal study on the effect of steroids on bone mineral density

Trapani

Civinini

Ermini

et al. 1998

Rheumatology International

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“…Trapani et al also reported an association between the cumulative steroid dose and BMD in patients with childhood-onset SLE (13), whereas Castro et al did not observe such an association (12). The impact of corticosteroids have been a subject of controversy (19,42,43), but some of the differences between studies may be attributable to patient selection, study design, and different uses of corticosteroids (i.e., high-dose, low-dose, oral, intravenous). Interestingly, in our patients, corticosteroids were not identified as predictors of bone loss in the distal one-third of the radius and the total body.…”

Section: Osteopenia In Patients With Childhood-onset Slementioning

confidence: 99%

“…through decreased formation and increased resorption of bone (21,22), but the impact of corticosteroids on bone loss in the setting of SLE is unclear (6,9,10,19).…”

mentioning

confidence: 99%

Frequency of osteopenia in children and young adults with childhood‐onset systemic lupus erythematosus

Lilleby¹,

Lien²,

Frøslie³

et al. 2005

Arthritis & Rheumatism

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Objective. To determine the frequency of osteopenia in patients with childhood-onset systemic lupus erythematosus (SLE) compared with that in healthy matched controls, and to evaluate the relationship between disease-related variables and bone mineral mass.Methods. Bone mineral density (BMD) and bone mineral content (BMC) were measured in a cohort of 70 patients with childhood-onset SLE (mean ؎ SD disease duration 10.8 ؎ 8.3 years, mean ؎ SD age 26.4 ؎ 9.9 years) and 70 age-and sex-matched healthy controls. BMD and BMC of the femoral neck, lumbar spine, total body, and distal one-third of the radius were measured by dual x-ray absorptiometry. We investigated the relationship between BMC and the following disease variables: cumulative dose of corticosteroids, organ damage, current use of corticosteroids, use of cyclophosphamide, age at disease onset, and disease activity at the time of diagnosis. Biochemical markers of bone metabolism were also measured.Results. BMD values for the lumbar spine and femoral neck were significantly lower in patients than in healthy controls. The reduction in BMD of the lumbar spine was significantly greater than that of the total body. In multiple linear regression analyses, a higher cumulative corticosteroid dose was significantly associated with lower BMC of the lumbar spine and femoral neck. Decreased lumbar spine BMC was also related to male sex.Conclusion. The frequency of osteopenia was higher in patients with childhood-onset SLE than in matched controls. The lumbar spine was the most seriously affected skeletal site, followed by the femoral neck. The cumulative dose of corticosteroids was shown to be an important explanatory variable for BMC values in the lumbar spine and femoral neck.

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Frequency of fractures in women with systemic lupus erythematosus: Comparison with united states population data

Ramsey‐Goldman

Dunn

Huang

et al. 1999

Arthritis & Rheumatism

171

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Fractures occurred in 12.3% of lupus patients who were followed up for 5,951 person-years. There was nearly a 5-fold increase in fracture occurrence in the women with lupus compared with women from the US population. Older age at lupus diagnosis and longer use of corticosteroids were associated with time from lupus diagnosis to fracture. With increased life expectancy of lupus patients, fracture occurrence is a major threat to the health of these women. Prevention strategies must be directed toward minimizing the occurrence of fractures in these patients.

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SLE and osteoporosis: dependence and/or independence on glucocorticoids

Cited by 34 publications

References 16 publications

Osteoporosis in juvenile systemic lupus erythematosus: a longitudinal study on the effect of steroids on bone mineral density

Osteoporosis in juvenile systemic lupus erythematosus: a longitudinal study on the effect of steroids on bone mineral density

Frequency of osteopenia in children and young adults with childhood‐onset systemic lupus erythematosus

Frequency of fractures in women with systemic lupus erythematosus: Comparison with united states population data

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