Effect of Combined Treatment With Bisphosphonate and Vitamin D on Atherosclerosis in Patients With Systemic Lupus Erythematosus

A Propensity Score-Based Analysis

Kazumasa Ohmura; Masaru Kato; Toshiyuki Watanabe; Kenji Oku; Toshiyuki Bohgaki; Tetsuya Horita; Shinsuke Yasuda; Yoichi M. Ito; Norihiro Sato; Tatsuya Atsumi


Arthritis Res Ther. 2018;20(72) 

In This Article


Preventing atherosclerosis is a key objective while monitoring patients with systemic lupus erythematosus (SLE). In addition to traditional risk factors, such as hypertension and diabetes mellitus, SLE-related risk factors including glucocorticoid use, disease activity, antiphospholipid antibodies, and renal manifestations, have been shown to promote atherosclerosis.[1] Owing to progress in the treatment of SLE, cardiovascular disease (CVD) has replaced lupus-related organ failure to become the main cause of morbidity and mortality in these patients.

The biological link between atherosclerosis and osteoporosis has been reported previously.[2,3] As with the β-hydroxy β-methylglutaryl-CoA (HMG-CoA) reductase inhibitors ("statins"), nitrogen-containing bisphosphonates have been known to inhibit the mevalonate pathway through interaction with farnesyl pyrophosphate synthase and are therefore expected to interfere with intimal plaque formation.[4] Vitamin D deficiency is emerging as a novel risk factor for CVD.[5] However, it remains controversial whether bisphosphonate (BP) therapy or vitamin D (VD) supplementation is prophylactic against atherosclerosis. Currently, there are no data to establish correlation between the development of atherosclerosis and treatment with BP and/or VD, which are frequently prescribed in patients with lupus. We hypothesized that combined treatment with BP + VD may be negatively associated with the progression of atherosclerosis in patients with SLE and herein report an unbiased study using propensity scoring.