Background/Purpose: Premature atherosclerosis is one of the major complications of systemic lupus erythematosus (SLE). Preventing atherosclerosis is a key objective while monitoring patients with SLE. Recently, the biological linkage between atherosclerosis and osteoporosis has garnered much attention. The aim of this study was to explore and evaluate associations between development of atherosclerosis and anti-osteoporotic treatment. We focused on the combined treatment with bisphosphonate and vitamin D (BP+VD) on atherosclerosis and performed an unbiased cross-sectional and longitudinal study using inverse probability of treatment weighting (IPTW) based on propensity score.

Methods: Two hundred and twenty one SLE patients who received glucocorticoids (GC) at Hokkaido University Hospital between January 2012 and August 2014 were examined. Of these patients, patients who underwent carotid ultrasonography to assess subclinical atherosclerosis in clinical practice were enrolled in this study. Carotid ultrasonography was performed at baseline and during the follow-up period. Carotid plaque and plaque scores were defined as surrogate markers of subclinical atherosclerosis. Propensity score was calculated for each patients as the probability of receiving BP+VD treatment, using 8 baseline covariates including age, postmenopausal state, duration of disease, duration of GC use, current dose of GC, statin use, bone mineral status and SLEDAI-2K.

Results: A total of 108 consecutive patients with SLE were included in this study. Thirty-seven (34%) were receiving BP+VD, 26 (24%) BP alone, 29 (27%) VD alone, and 16 (%) other agents to treat or prevent osteoporosis. In 12 out of 108 patients, the propensity score could not be estimated due to unavailability of the baseline covariates. Eighty-three out of 108 patients underwent a re-evaluation of carotid ultrasonography after 104±21 months (mean ± SD). After adjustment with IPTW, the prevalence of carotid plaque at baseline was significantly less frequent in BP+VD than other treatment groups (p=0.03, McNemar test). The progression of plaque scores between baseline and follow-up was also significantly less frequent in BP+VD group (p=0.006).

Conclusion: Combined treatment with BP+VD may prevent atherosclerosis in patients with SLE. This study suggested that the new strategy in terms of preventing atherosclerosis and reducing morbidity and mortality in SLE patients might include those anti-osteoporotic medications.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/preventive-effect-of-combined-treatment-with-bisphosphonate-and-vitamin-d-on-atherosclerosis-in-patients-with-systemic-lupus-erythematosus/