Background/Purpose: Observational studies have indicated a high but heterogeneous prevalence of low bone mineral density (BMD) and vertebral fractures (FV) in patients with systemic lupus erythematosus (SLE). The aim of this meta-analysis was to evaluate the relationship of SLE and BMD, osteoporosis and vertebral fracture risk.

Methods: A systematic review and meta-regression analysis were performed following the Preferred Reporting Items for Systematic Meta- Analyses (PRISMA) guidelines. Articles were identified from electronic databases (PubMed, Embase, VHL, SciELO and the Cochrane Library). The search was conducted using MesH terms, Boolean operators and keywords, which included “systemic lupus erythematosus”, “osteoporosis”, “bone mineral density” and “vertebral fractures”. Prospective longitudinal and cross-sectional studies were considered for review without language restrictions. Articles were screened for suitability and those selected were evaluated by two investigators who extracted information on study characteristics, outcomes of interest, risk of bias and summarized strength of evidence. Data was extracted where studies met inclusion criteria and were of sufficient quality. BMD reported as the mean ± standard deviation evaluated by dual-energy X-ray absorptiometry (DXA) was analyzed including information of SLE cases and controls, treatment, menopausal status and fractures through a meta-regression analysis adjusted by anatomical region. Data were analyzed using the Metafor package in R (3.0.2 version).

Results: In total 54 articles were identified and analyzed (12593 SLE cases/six anatomical regions and 14235 controls/six anatomical regions). SLE women had less BMD than healthy controls (p< 0,0001), however, in SLE men this difference was absent when they were compared to controls. When only SLE patients were analyzed, the BMD measurements were not statistically different between those with a background of corticosteroid (CTS) therapy and those without CTS therapy. Not surprisingly, postmenopausal SLE patients had lower BMD (lumbar spine and total hip) compared to premenopausal patients (p< 0,0001). The BMD was not different between patients with and without fractures.

Conclusion: This systematic review and meta-regression depicts that women with SLE had higher risk of low BMD than healthy controls. These data did not show that CTS therapy had an impact on BMD.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/osteoporosis-and-vertebral-fractures-in-patients-with-systemic-lupus-erythematosus-a-systematic-review-and-meta-analysis/