Six-year follow-up study of bone mineral density in patients with systemic lupus erythematosus
Six-year follow-up study of bone mineral density in patients with systemic lupus erythematosus
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DOI：
10.1007/s00198-012-2157-9
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发表时间：
2013-06-01
影响因子：
4
通讯作者：
Bultink, I. E. M.
中科院分区：
文献类型：
--
作者：
Jacobs, J.;Korswagen, L. -A.;Bultink, I. E. M.
对系统性红斑狼疮(SLE)患者的远期骨密度(BMD)变化及其相关因素进行了研究。尽管总体骨丢失非常低，但使用糖皮质激素、使用抗疟疾药物和较低的25-羟基维生素D水平与显著的脊柱骨丢失有关，强调了预防SLE患者骨质疏松和维生素D缺乏的重要性。本研究的目的是评估SLE患者的骨密度变化并确定相关因素。收集了126名SLE患者的人口学和临床数据，并在基线和随访时用双能X射线骨密度仪测量腰椎和全髋部的骨密度。统计分析使用独立的Mann-Whitney U检验和线性回归分析。在基线时，39.7%的患者(90%女性，平均年龄39+/-12.2岁)有骨量减少，6.3%的患者有骨质疏松症。中位随访时间为6.7年(1.9~9.3年)。腰椎(-0.08%/年)和髋部(-0.20%/年)的平均骨密度变化不显著。在随访期间，70%的患者使用了糖皮质激素。平均每日+/-SD糖皮质激素剂量为5.0+/-5.0 mg。在多元回归分析中，脊柱骨密度下降与较高的每日糖皮质激素剂量和较低的基线25-羟基维生素D水平显著相关。髋部骨密度丢失与基线水平较低的25-羟基维生素D水平、体重指数的降低和抗疟药的基线使用有关。在这项为期6年的随访研究中，骨丢失非常低。糖皮质激素的使用和脊柱骨丢失之间存在剂量依赖关系。此外，抗疟疾药物的使用和基线时较低的25-羟基维生素D水平与骨密度下降有关。这些发现强调了预防和治疗系统性红斑狼疮患者维生素D缺乏和骨质疏松的重要性，特别是在使用糖皮质激素或抗疟疾药物的患者。
Long-term bone mineral density (BMD) changes and the associated factors in systemic lupus erythematosus (SLE) patients were assessed. Despite the remarkably low overall bone loss, significant spine bone loss was associated with the use of glucocorticoids, use of antimalarials, and lower 25-hydroxyvitamin D levels, stressing the importance of prevention of osteoporosis and vitamin D deficiency in SLE patients.The aim of this study is to assess the BMD changes in patients with SLE and to identify the associated factors.Demographic and clinical data of 126 SLE patients were collected, and BMD measurements of the lumbar spine and the total hip were performed by dual-energy X-ray absorptiometry at baseline and follow-up. Statistical analyses were performed using independent Mann-Whitney U tests and linear regression analyses.At baseline, 39.7 % of the patients (90 % female, mean age 39 +/- 12.2 years) had osteopenia, and 6.3 % had osteoporosis. The median follow-up duration was 6.7 years (range 1.9-9.3 years). Mean changes in BMD at the lumbar spine (-0.08 %/year) and the hip (-0.20 %/year) were not significant. During follow-up, 70 % of the patients used glucocorticoids. The mean +/- SD daily glucocorticoid dose was 5.0 +/- 5.0 mg. In multiple regression analysis, BMD loss at the spine was significantly associated with higher daily glucocorticoid dose and lower baseline 25-hydroxyvitamin D levels. BMD loss at the hip was associated with lower 25-hydroxyvitamin D levels at baseline, reduction of body mass index, and baseline use of antimalarials.In this 6-year follow-up study, bone loss was remarkably low. A dose-dependent relationship between glucocorticoid use and spinal bone loss was found. In addition, the use of antimalarials and lower 25-hydroxyvitamin D levels at baseline were associated with BMD loss. These findings underline the importance of prevention and treatment of vitamin D deficiency and osteoporosis in SLE, especially in patients using glucocorticoids or antimalarials.