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Chronic renal failure, certain medications linked with higher osteoporosis risk in patients with SLE
Patients with systemic lupus erythematosus who also had chronic renal failure and chronic treatment with anticoagulants or antiepileptic medications were at a higher risk for osteoporosis and fragility fractures, according to researchers in Italy.
A group of 186 patients with systemic lupus erythematosus (SLE) were evaluated. Six patients were men. All patients in the study were white and treated with glucocorticoids for a minimum of 6 months prior to inclusion. Supplementation of 500-mg calcium and vitamin D was reported by 155 patients. In addition to a clinical evaluation, investigators assessed patients’ bone mineral density (BMD) of the lumbar spine (L1 to L4) and non-dominant hip (total hip and femoral neck) using dual-energy X-ray absorptiometry.
The mean serum value of 25OH-D was 21.8 ng/mL, and serum calcium was 9.3 mg/dL. The mean parathyroid hormone level was 47.4 pg/mL. Hypovitaminosis D was experienced at least once in 147 patients, 97 patients were vitamin D deficient and 50 patients had insufficient levels of vitamin D.
At the last observation, the mean T-scores were -1.43, -1.38 and -1.29 in the vertebrae, femoral neck and total femur, respectively. Reduced BMD was observed in 97 patients and 52 patients had BMD consistent with osteoporosis. An inverse association was seen between T-scores and age and disease duration. The mean age at the time of osteoporosis diagnosis was 49.9 years.
A univariate analysis revealed that osteoporosis correlated with age, cumulative glucocorticoid use, therapy with antiepileptic medications and cumulative use of anticoagulants. After multivariate logistic regression, an association remained for age, postmenopausal status and antiepileptic therapy. Levels of 25OH-D at last observation were not associated with BMD values.
At least one fragility fracture occurred in 22 patients. Investigators found 16 patients had more than one fragility fracture. Of the 40 fragility fractures identified, 29 were in the vertebrae; six were in the costae; three were in the femur; and two were in the ribs. All fragility fractures identified occurred in women, and 16 of these patients were post-menopausal. Of the patients with fragility fractures, 45.5% had a history of anticoagulant use; 27.3% were treated with antiepileptic medication; and 27.3% had chronic renal failure. – by Shirley Pulawski
Disclosure: The researchers report no relevant financial disclosures.