Men's Osteoporosis Support GroupBone health in systemic lupus erythematosus - two articles Curr Rheumatol Rep. 2009 Jul;11(3):177-84. Bone health in systemic lupus erythematosus. Panopalis P, Yazdany J. PMID: 16604461. Systemic lupus erythematosus is a potentially serious medical condition of largely unknown cause that affects women much more commonly than men. Since this condition and/or its treatment can lead to bone health problems, there are two recent articles that I want to mention in this Update. This first review article points to the many osteoporosis risk factors that people with SLE have, including the traditional risk factors that everyone has. These SLE-related risk factors include: chronic, systemic inflammation, vitamin D deficiency due to sun avoidance, premature gonadal failure, and the chronic use of medications known to increase osteoporosis risk. The authors suggest that preventive and treatment measures, such as vitamin D and calcium supplementation and/or taking an FDA-approved osteoporosis medication may be warranted to prevent bone-related complications for those with SLE. J Rheumatol. 2009 Jul 15. [Epub ahead of print]. High Prevalence of Asymptomatic Vertebral Fractures in Chinese Women with Systemic Lupus Erythematosus. Li EK and others. PMID: 19605677. This study was specifically targeted to Chinese women with SLE, so whether the results apply equally to men is uncertain. Most likely the one element that would apply only to women in this study would be their exposure to estrogen, either naturally or as hormone replacement therapy. The other variables appear to be applicable to either gender with SLE, specifically: variables associated with fractures were older age, higher body mass index (BMI), lower BMD spine, lower BMD hips, higher serum C3 and C4 (complement protein levels), higher levels of OPG (osteoprotegerin), and the use of sunscreen. An important finding was that asymptomatic vertebral fractures occurred in 20.4% of patients with SLE and 30% of these patients had normal bone mineral density (BMD). The authors concluded, "The current method using DEXA to predict the presence of vertebral fracture has limited value and there is a need for assessment of bone quality. Vertebral morphometry in patients with SLE is recommended and early therapeutic intervention is necessary to prevent vertebral fractures in patients with SLE." Editor's comments: The bottom line from these articles is that individuals with SLE, whether they are male or female, are at increased risk for osteoporosis and fractures. Quite unusual is the finding that individuals with SLE apparently have poor quality BMD which makes them fracture-prone while having normal DXA results. This means standard osteoporosis evaluation may not detect the potential increased fracture risk for these individuals with SLE. If you have SLE and are reading this, your physician may not be aware of this increased fracture risk you have. So print a copy of the abstract of the Li and others article to provide him or her. Of particular importance would be supplementation with vitamin D since sunshine avoidance is a key treatment strategy for those with SLE. If individuals are also taking glucocorticoids as part of their therapy, then they should be on an FDA-approved osteoporosis medication. If you have SLE and your care provider isn't taking proper preventive and treatment steps, it behooves you to explain the need for such therapy based upon the findings in these two articles, and others.
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