Therapy insight: osteoporosis and osteonecrosis in systemic lupus erythematosus

ABSTRACT 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. KEY POINTS * Survival of patients with systemic lupus erythematosus has improved, such that treatment is now focused on minimizing the organ damage associated with either the

disease itself or the medications used to treat it * Systemic inflammation increases osteoclast maturation and reduces osteoblast maturation and activity, such that rapid bone loss can occur

* Compared with cortical bone, trabecular bone is more severely affected by systemic inflammation and other metabolic changes, owing to its high turnover rate * Patients should be carefully

evaluated for bone health via measurement of bone mineral density, and laboratory evaluation of levels of calcium and vitamin D and biochemical markers of bone turnover * Prevention and

treatment of bone loss in systemic lupus erythematosus is multifaceted and should include aggressive reduction of systemic inflammation, antiresorptive agents (if a patient has had a

fracture or has a low bone mineral density), and appropriate supplementation of calcium and vitamin D Access through your institution Buy or subscribe This is a preview of subscription

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INSIGHTS ON THE PATHOGENESIS, DIAGNOSIS, PREVENTION AND THERAPEUTICS Article Open access 17 March 2025 HIGH DISEASE ACTIVITY CORRELATE WITH DECREASED SERUM CALCIUM IN SYSTEMIC LUPUS

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AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Endowed Professor of Medicine and Rheumatology at the University of California, Davis Medical School, Sacramento Nancy E Lane * Director of the

Center for Healthy Aging, Nancy E Lane * Vice-Chair for Research for the Department of Medicine at the University of California at Davis, CA, USA Nancy E Lane Authors * Nancy E Lane View

author publications You can also search for this author inPubMed Google Scholar ETHICS DECLARATIONS COMPETING INTERESTS The author declares no competing financial interests. RIGHTS AND

PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Lane, N. Therapy Insight: osteoporosis and osteonecrosis in systemic lupus erythematosus. _Nat Rev Rheumatol_ 2,

562–569 (2006). https://doi.org/10.1038/ncprheum0298 Download citation * Received: 27 January 2006 * Accepted: 15 August 2006 * Issue Date: 01 October 2006 * DOI:

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