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2018 ; 102
(5
): 575-591
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Bone Disease in Connective Tissue Disease/Systemic Lupus Erythematosus
#MMPMID28900675
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Calcif Tissue Int
2018[May]; 102
(5
): 575-591
PMID28900675
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This article reviews recent advances in the research of the mechanisms of bone
loss, as well as clinical features, economic impact and therapeutic implications
of osteoporosis and fractures in patients with systemic lupus erythematosus (SLE)
as an illustration of bone disease in a complex systemic autoimmune connective
tissue disease. Recent studies demonstrated an increased incidence of
osteoporosis and peripheral and vertebral fractures in patients with SLE. The
aetiology of bone loss in SLE is multifactorial, including clinical osteoporosis
risk factors, systemic inflammation, serological factors, metabolic factors,
hormonal factors, possibly genetic factors and medication-induced adverse
effects. The incidence of symptomatic fractures in patients with SLE is increased
1.2-4.7-fold and age, disease duration, glucocorticoid use, previous
cyclophosphamide use, seizures and a prior cerebrovascular event have been
identified as important risk factors. Moreover, a high prevalence of morphometric
vertebral fractures was demonstrated, while one in three of these patients has
normal bone density, which finding points to the multifactorial aetiology of
fractures in SLE. The clinical consequences and economic burden of osteoporosis
and fractures as glucocorticoid treatment-related adverse events and the high
frequency of glucocorticoid therapy underline the importance of reducing
glucocorticoid treatment and prescribing steroid-sparing agents. No data on fall
risk and its determinants and the relationship with the occurrence of fractures
in patients with SLE are currently available. Fall risk might be increased in
lupus patients for several reasons. In addition, the recently reported high
prevalence (20%) of frailty in SLE patients may contribute to the increased
fracture incidence. Therefore, the relationships between fall risk, frailty and
fracture occurrence in SLE might be interesting subjects for future studies.
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