Uncoupled bone remodeling is characteristic of bone damage in premenopausal women with new-onset systemic lupus erythematosus

Abstract

Objective To investigate the mechanism underlying systemic lupus erythematosus (SLE)-related bone loss by evaluating the bone mineral density (BMD) and bone turnover markers (BTMs) in premenopausal patients with new-onset SLE without any treatment. Methods BMD and BTMs of 106 premenopausal patients with new-onset SLE and 64 gender-, age- and body mass index (BMI)-matched healthy controls were analyzed. BMD was determined using dual energy X-ray absorptiometry (DXA). Serum BTMs were measured. Results Hip and lumbar spine BMD in premenopausal patients with new-onset SLE was significantly decreased compared with healthy controls. Higher rate of osteoporosis was observed in new-onset SLE patients (25% vs. 1%). Moreover, uncoupled bone remodeling evidenced by an increase in bone resorption marker β-CTX (685.9 ± 709.6 pg/mL vs. 395.4 ± 326.0 pg/mL, P < 0.05) and decrease in bone formation markers PINP (37.4 ± 33.0 ng/mL vs. 46.1 ± 20.9 ng/mL, P < 0.05) and OC (11.4 ± 9.8 ng/mL vs. 18.2 ± 8.6 ng/mL, P < 0.05) was observed in premenopausal patients with new-onset SLE compared with healthy controls. Univariate correlation analyses showed negative correlations between OC and SLE Disease Activity Index (SLEDAI), and positive correlations between β-CTX and SLEDAI. SLE patients positive for dsDNA, nucleosome showed lower OC and higher β-CTX. Conclusion Premenopausal patients with new-onset SLE had decreased BMD and abnormal bone metabolism with increased β-CTX and decreased OC and P1NP levels, indicating uncoupled bone remodeling in new-onset SLE patients. Disease activity and abnormal immunity, especially the amount of antibodies in SLE patients, were strongly associated with abnormality of bone metabolism.

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“…Osteopenia occurs already in pre-menopausal SLE patients but worsens significantly after menopause. 4 Additionally, a recent publication showed lower BMD in pre-menopausal SLE patients compared with healthy controls, 5 further highlighting the risk for osteoporosis development in these patients. SLE patients also have an almost 3-fold increased risk of vertebral fractures compared with age-matched controls.…”

Therapeutic Treatments for Osteoporosis—Which Combination of Pills Is the Best among the Bad?

“…The number of risk factors can increase the chances of developing osteoporosis. Patients with the following medical problems have a higher risk for developing osteoporosis: cancer, in particular breast cancer [98,99], rheumatoid disorders such as rheumatoid arthritis [100,101] or systemic lupus erythematosus [102], chronic kidney or liver diseases [103,104], diabetes mellitus [105,106], Parkinson's disease [107], and multiple myeloma [108]. Eating disorders such as anorexia [109] nervosa, poor nutrition, or dietary factors such as a low calcium intake [110] can also cause osteoporosis, as calcium plays an important role in the development of bone.…”

Glucocorticoid-induced osteoporosis in premenopausal women: management for the rheumatologist

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