Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Five Year Follow-Up Study of Bone Mineral Density in Patients with Systemic Lupus Erythematosus: The Influence of Corticosteroid Treatment.
Schilder, Anna M., Jacobs, Jonathan, Korswagen, Lindy-Anne, Dijkmans, Ben A. C., Lems, Willem F., Voskuyl, Alexandre E., Bultink, Irene E. M.
Introduction and Objective:
The influence of corticosteroids on bone mineral density (BMD) in systemic lupus erythematosus (SLE) is still under debate. Various studies have reported an association between corticosteroid use and low BMD in SLE but other studies did not demonstrate a significant relationship. This discrepancy might be explained partially by the cross-sectional design of the far majority of studies. Only a few longitudinal studies on BMD change and the associated factors in patients with SLE have been performed. However, in these studies, the numbers of patients were small and the duration of follow-up was relatively short (three years).
The aim of this study was to assess change in BMD during long-term follow-up in patients with SLE and to identify factors associated with BMD loss. In particular the effect of corticosteroid treatment on BMD change was studied.
We prospectively studied 82 patients with SLE. Demographic and clinical data were collected and BMD measurements of the lumbar spine and total hip were performed by dual energy x-ray absorptiometry at baseline and at follow-up. 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. Statistical analysis was performed using independent sample t-test for comparison of means, univariate and multiple regression analysis.
At baseline, osteopenia was present in 49% of the patients and osteoporosis in 9% (93% female, mean age 38.8 years, mean disease duration 6.3 years). During the observation period, 67.1% of the patients were treated with corticosteroids. The mean cumulative dose of prednisone used between baseline and follow-up was 13.4 ± 8.5 grams. The mean daily dose of prednisone was 6.6 ± 3.9 mg in the corticosteroid users.
After a mean follow-up of 5.7 years, no significant change in BMD of the total hip or the lumbar spine was observed at group level. However, higher cumulative corticosteroid dose during the observation period was significantly associated with BMD loss in the lumbar spine, but not at the hip (p = 0.851). A mean daily dose of more than 7.5 mg prednisone was associated with significant BMD loss at the lumbar spine as compared to patients receiving less than 7.5 mg per day (P = 0.003).
In this long-term follow-up study, no significant change in BMD of the lumbar spine or the total hip is observed in patients with SLE. However, higher mean daily and cumulative corticosteroid dose is associated with BMD loss in the lumbar spine. The high prevalence of reduced BMD and the negative influence of corticosteroid use on bone density in the lumbar spine underline the importance of permanent attention for monitoring and treatment of low BMD in SLE, especially in patients using higher doses of corticosteroids.
To cite this abstract, please use the following information:
Schilder, Anna M., Jacobs, Jonathan, Korswagen, Lindy-Anne, Dijkmans, Ben A. C., Lems, Willem F., Voskuyl, Alexandre E., et al; Five Year Follow-Up Study of Bone Mineral Density in Patients with Systemic Lupus Erythematosus: The Influence of Corticosteroid Treatment. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1859