Therapy Insight: Osteoporosis and Osteonecrosis in Systemic Lupus Erythematosus

Nancy E Lane

Disclosures

Nat Clin Pract Rheumatol. 2006;2(10):562-569. 

In This Article

Summary and Introduction

Summary

Survival of patients with systemic lupus erythematosus (SLE) has improved over the past decade, thanks to improved treatment of the disease, which now results in fewer fatal complications. This improvement has allowed physicians to focus their attention on the prevention of organ damage caused by this chronic, inflammatory disease, and by the medications used to control the disease. Osteoporosis is common in SLE patients; risk factors for osteoporosis include prolonged use of glucocorticoids, cyclophosphamide and possibly gonadotropin-releasing-hormone agonists. In premenopausal women with SLE, inflammation or SLE-related medications can increase bone turnover, which eventually weakens bone architecture, then reduces bone strength and increases the risk of fracture. Prevention and treatment of osteoporosis in SLE patients should entail a multifaceted approach. Levels of calcium, vitamin D and homocysteine should be evaluated, and age-appropriate supplementation instituted. The bone loss that results from systemic inflammation should be treated by reduction of the inflammation with glucocorticoids, potent anti-inflammatory agents or antiresorptive agents. The efficacy of this therapy can be monitored using bone mineral density scans. This Review briefly discusses the pathophysiology of the localized and generalized osteoporosis and osteonecrosis in SLE patients and recommends therapies to both prevent and treat these unfortunate complications of this disease.

Introduction

Systemic lupus erythematous (SLE) is a chronic, multisystem autoimmune disease of unknown etiology that predominantly affects women. The treatment used to control disease activity often results in substantial morbidity and mortality. The improved treatments for SLE have, however, reduced complications and prolonged survival. This improvement has allowed physicians who treat patients with SLE to turn their attention to the organ damage and morbidity associated with this disease, including osteoporosis, accelerated atherosclerotic disease, osteonecrosis and premature gonadal failure. This article briefly discusses the pathophysiology of the localized and generalized osteoporosis and osteonecrosis that occur in patients with SLE, and recommends therapies to prevent and treat these unfortunate complications.

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