Objectives: Osteoporosis and compression fractures of the lumbar spine are some of the major adverse effects of glucocorticoid therapy in patients with systemic lupus erythematosus (SLE). This study examined the association between bone mineral density, bone turnover markers, presence of vertebral fractures, and Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index (SDI) in SLE patients.
Methods: This was a cross-sectional study of 246 outpatients with SLE at the Kyoto University Hospital. Lumbar and femoral BMD were measured with dual-energy X-ray absorptiometry, and presence of vertebral fractures was determined using X-ray, CT, or MR imaging.
Results: On multiple regression analysis, high lumbar and femoral T-scores were both associated with concomitant use of hydroxychloroquine (p = 0.018 and p = 0.037, respectively), no use of bisphosphonate or denosumab (p = 0.004 and p = 0.038, respectively), high body mass index (p < 0.001), and low bone-specific alkaline phosphatase (BAP) level (p = 0.014 and p = 0.002, respectively). Vertebral fractures showed a significant association with SDI score (p < 0.001) and femoral T-score (p < 0.001).
Conclusions: Vertebral fracture was associated with SLE-associated organ damage and serum BAP level is a potentially useful marker for osteoporosis monitoring in SLE patients.
Keywords: Bone mineral density; Bone-specific alkaline phosphatase; Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index score; Systemic lupus erythematosus; Vertebral fractures.
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