Abstract
The aim of this study was to determine the prevalence and risk factors for low bone mineral density (BMD) in women with systemic lupus erythematosus (SLE). A cross-sectional study was conducted among 100 pre-menopausal patients with SLE. Patients were evaluated using a questionnaire about the following variables: age, disease duration, disease activity, chronic disease damage, cumulative corticosteroid dose, and history of fracture. Lumbar spine and hip measurements of BMD were performed by dual absorptiometry. Univariate and multivariate statistical analyses were used to assess the relationship between risk factors and BMD. The mean age was 32.8 ± 8.7 years, and the median duration of SLE was 73.2 ± 65 months. The mean cumulative corticosteroid dose was 20.0 ± 21.3 g. The mean BMD was 1.09 ± .18 g/cm2 in the lumbar spine and 1.0 ± .14 g/cm2 in the hip. Osteopenia was present in 40% of patients and osteoporosis in 5%. In the multiple regression analysis, low BMD in the lumbar spine was associated with chronic disease damage and low body mass index (BMI). Low BMD in the hip was associated with cumulative corticosteroid dose and low BMI. Chronic disease damage, low BMI, and cumulative corticosteroid dose are risks factors for low BMD in pre-menopausal SLE patients. Osteopenia was found in 40% of patients, while osteoporosis was found in only 5%.
Similar content being viewed by others
References
Croker JA, Kimberly RP (2005) SLE: challenges and candidates in human disease. Trends Immunol 26:580–586
Uramoto KM, Michet CJ Jr, Thumboo J, Sunku J, O’Fallon WM, Gabriel SE (1999) Trends in the incidence and mortality of systemic lupus erythematosus, 1950–1992. Arthritis Rheum 42:46–50
Cervera R, Khamashta MA, Font J et al (2003) Morbidity and mortality in systemic lupus erythematosus during 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients. Medicine 82:299–308
Cooper C, Atkinson EJ, Jacobsen SJ, O’Fallon WM, Melton LJ 3rd (1993) Population-based study of survival after osteoporotic fractures. Am J Epidemiol 137:1001–1005
Loker AC, Johnston CC Jr, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP, Lindsay RL (1995) Prevalence of low femoral bone density in older US women from Nhanes III. J Bone Miner Res 10:796–802
Hou YL, Wu XP, Luo XH, Zhang H, Cao XZ, Jiang YB, Liao EY (2007) Differences in age-related bone mass of proximal femur between Chinese women and different ethnic women in the United States. J Bone Miner Metab 25:243–252
Taaffe DR, Villa ML, Holloway L, Marcus R (2000) Bone mineral density in older non-Hispanic Caucasian and Mexican-American women: relationship to lean and fat mass. Ann Hum Biol 27:331–344
Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ, Rothfield NF (1982) The 1982 revised criteria of the classification of systemic lupus erythematosus. Arthritis Rheum 25:1271–1277
Hochberg MC (1997) Updating the American College of Rheumatology revised classification of systemic lupus erythematosus [letter]. Arthritis Rheum 40:1725
Steinbrocker O, Traeger CH, Batterman RC (1949) Therapeutic criteria in rheumatic disease. J Am Med Assoc 25:1–11
Guzman J, Cardiel MH, Arce-Salinas A, Sanchez-Guerrero J, Alarcon-Segovia D (1992) Measurement of disease activity in systemic lupus erythematosus. Prospective validation of 3 clinical indices. J Rheumatol 19:1551–1558
Gladman D, Ginzler E, Goldsmith C, Fortin P, Liang M, Urowitz M et al (1996) The development and initial validation of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index for systemic lupus erythematosus. Arthritis Rheum 39:363–369
World Health Organization Study Group (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Technical Report Series 843. WHO, Geneva, pp 2–25
Kalla AA, Kataar AB, Jessop SJ, Bewerunge L (1993) Loss of trabecular bone mineral density in systemic lupus erythematosus. Arthritis Rheum 36:1726–1734
Lopez AE, Tellez MM, Hernandez M, Clark P, Juarez SA, Lazcano EC, Salmeron J (2004) Predictors of bone mineral density in female workers in Morelos state, Mexico. Arch Med Res 35:172–180
Gordon C (2002) Long-term complications of systemic lupus erythematosus. Rheumatology (Oxford) 41:1095–1100
Kipen Y, Buchbinder R, Forbes A, Strauss B, Littlejohn G, Morand E (1997) Prevalence of reduced bone mineral density in systemic lupus erythematosus and the role of steroids. J Rheumatol 24:1922–1929
Redlich K, Ziegler S, Kiener HP, Spitzauer S, Stohlawetz P, Bernecker P et al (2000) Bone mineral density and biochemical parameters of bone metabolism in female patients with lupus erythematosus. Ann Rheum Dis 59:308–310
Li EK, Tam LS, Young RP, Ko GT, Li M, Lau EM (1998) Loss of bone mineral density in Chinese pre-menopausal women with systemic lupus erythematosus treated with corticosteroids. Br J Rheumatol 37:405–410
Gilboe IM, Kvien TK, Haugeberg G, Husby G (2000) Bone mineral density in systemic lupus erythematosus: comparison with rheumatoid arthritis and healthy controls. Ann Rheum Dis 59:110–115
Bultink I, Lems WF, Kostense PJ, Dijkmans BAC, Voskuyl AE (2005) Prevalence of and risk factors for low bone density and vertebral fractures in patients with systemic lupus erythematosus. Arthritis Rheum 54:2044–2050
Uaratanawong M, Utis D, Somrat L, Somsri U (2003) Bone mineral density in premenopausal women with systemic lupus erythematosus. J Rheumatology 30:2365–2368
Formiga F, Moga I, Nolla JM, Pac M, Mitjavila F, Roig-Escofet D (1995) Loss of bone mineral density in premenopausal women with systemic lupus erythematosus. Ann Rheum Dis 54:274–276
Pons F, Peris P, Guanabens N, Font J, Huguet M, Espinosa G et al (1995) The effect of systemic lupus erythematosus and long term steroid therapy on bone mass in pre-menopausal women. Br J Rheumatol 34:742–746
Sinigaglia L, Varenna M, Binelli L, Zucchi F, Ghiringhelli D, Gallazi M et al (1999) Determinants of bone mass in systemic lupus erythematosus: a cross sectional study on premenopausal women. J Rheumatology 26:1280–1284
Lakshminarayanan S, Walsh S, Mohanraj M, Rothfield N (2001) Factors associated with low bone mineral density in female patients with systemic lupus erythematosus. J Rheumatology 28:102–108
Becker A, Fischer R, Scherbaum WA, Schneider M (2001) Osteoporosis screening in systemic lupus erythematosus. Lupus 10:809–814
Pineau CA, Urowitz MB, Fortin PJ, Ibanez D, Gladman DD (2004) Osteoporosis in systemic lupus erythematosus: factors associated with referral for bone mineral density studies, prevalence of osteoporosis and factors associated with reduced bone density. Lupus 13:436–441
Lee C, Almagor O, Dunlop DD, Manzi S, Spies S, Chadha AB et al (2006) Disease damage and low bone mineral density: an analysis of women with systemic lupus erythematosus ever and never receiving corticosteroids. Rheumatology 45:53–60
van Staa TP, Leufkens HGM, Abenhaim L, Zhang B, Cooper C (2000) Fractures and oral corticosteroids: relationship to daily and cumulative dose. Rheumatology 39:1389–1899
van Staa TP, Leufkens HGM, Cooper C (2002) The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis. Osteoporos Int 13:777–787
Dhillon VB, Davies MC, Hall ML, Round JM, Ell PJ, Jacobs HS et al (1990) Assessment of the effect of oral corticosteroids on bone mineral density in systemic lupus erythematosus: a preliminary study with dual energy X ray absorptiometry. Ann Rheum Dis 49:624–626
Formiga F, Nolla JM, Mitjavila F, Bonnin R, Navarro MA, Moga I (1996) Bone mineral density and hormonal status in men with systemic lupus erythematosus. Lupus 5:623–626
Formiga F, Moga I, Nolla JM, Navarro MA, Bonnin R, Roig-Escofet D (1997) The association of dehydroepiandrosterone sulphate levels with bone mineral density in systemic lupus erythematosus. Clin Exp Rheumatol 15:387–392
Bhattoa HP, Kiss E, Bettembuk P, Balogh A (2001) Bone mineral density, biochemical markers of bone turnover, and hormonal status in men with systemic lupus erythematosus. Rheumatol Int 21:97–102
Hansen M, Halberg P, Kollerup G, Pedersen Zbinden B, Horslev Peterson K, Hyldstruo L et al (1998) Bone metabolism in patients with systemic lupus erythematosus: effect of disease activity and glucocorticoid treatment. Scand J Rheumatol 27:197–206
Kalla AA, Kataar AB, Jessop SJ, Bewerunge L (1993) Loss of trabecular bone mineral density in systemic lupus erythematosus. Arthritis Rheum 36:1726–1734
Gordon C (2002) Long-term complications of systemic lupus erythematosus. Rheumatology (Oxford) 41:1095–1100
Bhattoa HP, Bettembuk P, Balogh A, Szegedi G, Kiss E (2002) Bone mineral density in women with systemic lupus erythematosus. Clin Rheumatol 21:135–141
Boyanov M, Roveba R, Popivanov P (2003) Bone mineral density changes in women with systemic lupus erythematosus. Clin Rheumatol 22:318–323
Houssiau FA, Lefebvre C, Depresseux G, Lambert M, Devogelaer JP, Deuxchaisnes N (1996) Trabecular and cortical bone loss in systemic lupus erythematosus. Br J Rheumatol 35:244–247
Almehed K, Forsblad d’Elia H, Kvist G, Ohlsson C, Carlsten H (2007) Prevalence and risk factors of osteoporosis in female SLE patients-extended report. Rheumatology 46:1185–1190
Coimbra IB, Costallat LT (2003) Bone mineral density in systemic lupus erythematosus and its relation to age at disease onset, plasmatic estradiol and immunosuppressive therapy. Jt Bone Spine 70:40–45
Yee C-S, Crabtree N, Skan J, Amft N, Bowman S, Situnayake D, Gordon C (2005) Prevalence and predictors of fragility fractures in systemic lupus erythematosus. Ann Rheum Dis 64:111–113
Tanaka Y, Watanabe K, Suzuki M, Saito K, Oda S, Suzuki H, Eto S, Yamashita U (1989) Spontaneous production of bone-resorbing lymphokines by B cells in patients with systemic lupus erythematosus. J Clin Immunol 9:415–420
Linker-Israeli M, Deans RJ, Wallace DJ, Prehn J, Ozeri-Chen T, Klinenberg JR (1991) Elevated levels of endogenous IL-6 in systemic lupus erythematosus. A putative role in pathogenesis. J Immunol 147:117–123
Disclosures
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mendoza-Pinto, C., García-Carrasco, M., Sandoval-Cruz, H. et al. Risks factors for low bone mineral density in pre-menopausal Mexican women with systemic lupus erythematosus. Clin Rheumatol 28, 65–70 (2009). https://doi.org/10.1007/s10067-008-0984-z
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-008-0984-z