Background/Purpose: Juvenile Systemic Lupus Erythematosus (jSLE) is a multisystem inflammatory disease frequently associated with bone mass loss. This reduction can be assessed through bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA). However, the Trabecular Bone Score (TBS) is a novel, complementary method to BMD that reflects bone microarchitectural quality and contributes to evaluating fragility fracture risk. The primary objective of this study was to assess TBS values derived from DXA scans of children and adolescents diagnosed with jSLE and to compare them with data from age- and sex-matched healthy controls. Secondary objectives included exploring associations between TBS and BMD; identifying risk factors potentially influencing TBS in jSLE—such as clinical parameters and glucocorticoid (GC) use—and assessing the occurrence of fragility fractures.
 

Methods: This was a retrospective observational analytical study including children and adolescents with jSLE aged 5–19 years. Clinical data and BMD values obtained by DXA between 2017 and 2022 at a quaternary care center were analyzed. Patients’ BMD and TBS data were compared with previously published reference data from healthy Brazilian children and adolescents, after appropriate age and sex matching, to facilitate interpretation of potential bone mass reduction.

Results: Ninety-four DXA scans from 50 patients were analyzed. Twenty-one scans showed altered TBS values. Overall, patients with jSLE presented lower TBS scores (mean difference, −0.067 ± 0.113; p < 0.0001). Female patients aged 14–16 and 17–19 years had significantly lower TBS values compared with controls (p < 0.0001 and p = 0.0004, respectively). BMD and TBS were concordant in 80/94 (85.1%) scans, showing a moderate positive correlation (Matthews correlation coefficient ϕ = 0.56; p < 0.0001). TBS values were not associated with disease duration, high disease activity, cumulative GC dose, or occurrence of fragility fractures.

Conclusion: Children and adolescents with jSLE exhibited lower TBS values compared with healthy peers, suggesting impaired bone microarchitecture.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/bone-microarchitecture-impairment-in-juvenile-systemic-lupus-erythematosus-patients-a-comparative-study/