Prevalence of and risk factors for low bone mineral density and vertebral fractures in patients with systemic lupus erythematosus

Arthritis Rheum. 2005 Jul;52(7):2044-50. doi: 10.1002/art.21110.


Objective: To examine the prevalence of and risk factors for low bone mineral density (BMD) and vertebral fractures in patients with systemic lupus erythematosus (SLE).

Methods: We studied 107 SLE patients. Demographic and clinical data were collected, and radiographs of the thoracic and lumbar spine and BMD measurements by dual x-ray absorptiometry were performed. Vertebral deformities were scored according to the method of Genant et al: fractures were defined as a reduction of > or = 20% of the vertebral body height. Osteoporosis was defined as a T score less than -2.5 SD and osteopenia as a T score less than -1.0 SD in at least 1 region of measurement.

Results: Osteopenia was present in 39% of the patients and osteoporosis in 4% (93% female; mean age 41.1 years). In multiple regression analysis, low BMD in the spine was associated with a low body mass index (BMI), postmenopausal status, and 25-hydroxyvitamin D deficiency. Low BMD in the hip was associated with low BMI and postmenopausal status. At least 1 vertebral fracture was detected in 20% of the patients. Vertebral fractures were associated with ever use of intravenous methylprednisolone and male sex.

Conclusion: Risk factors for low BMD in SLE patients are low BMI, postmenopausal status, and vitamin D deficiency. While osteoporosis defined as a low T score was found in only 4% of the patients, osteoporotic vertebral fractures were detected in 20%. The high prevalence of low BMD and vertebral fractures implies that more attention must be paid to the prevention and treatment of osteoporosis and fractures in SLE.

MeSH terms

  • Absorptiometry, Photon
  • Adult
  • Bone Density*
  • Female
  • Health Status
  • Humans
  • Lumbar Vertebrae / diagnostic imaging
  • Lumbar Vertebrae / metabolism
  • Lupus Erythematosus, Systemic / complications*
  • Lupus Erythematosus, Systemic / metabolism
  • Lupus Erythematosus, Systemic / pathology
  • Male
  • Osteoporosis, Postmenopausal / epidemiology
  • Osteoporosis, Postmenopausal / etiology*
  • Osteoporosis, Postmenopausal / metabolism
  • Prevalence
  • Risk Factors
  • Severity of Illness Index
  • Spinal Fractures / epidemiology
  • Spinal Fractures / etiology*
  • Spinal Fractures / metabolism
  • Thoracic Vertebrae / diagnostic imaging
  • Thoracic Vertebrae / metabolism