Longitudinal analysis of bone mineral density in pre-menopausal female systemic lupus erythematosus patients:: deleterious role of glucocorticoid therapy at the lumbar spine

Objective. To evaluate whether bone loss occurs over time in pre-menopausal systemic lupus erythematosus (SLE) patients. Methods. We performed a longitudinal bone mineral density (BMD) analysis in a group of 35 pre-menopausal female SLE patients. Lumbar spine and hip (total and sub-regions) BMDs were measured twice 21 +/- 11 (mean +/- S.D.) months apart by dual-energy X-ray absorptiometry. Results. In the whole cohort of SLE patients, significant bone loss was observed at the lumbar spine (-1.22%/yr) but not at the total hip. Further analyses indicated that lumbar spine bone loss (-2.12%/yr) occurred exclusively in the subgroup of patients who had taken a mean prednisolone daily dose >7.5 mg between the two BMD measurements. Moreover, bone loss was more important in patients who had previously received a cumulative prednisolone dose less than or equal to 5 g by the time of their first BMD evaluation. Conclusions. These results, by demonstrating a loss of lumbar spine bone over lime in premenopausal SLE patients given glucocorticoid (GC) therapy, strongly support the use of preventive treatment to minimize GC-induced osteoporosis in pre-menopausal female SLE patients given prednisolone daily doses >7.5 mg.