Bone mass in systemic lupus erythematosus

As a consequence of the chronic course of the disease osteoporosis can be a further clinical challenge in patients with systemic lupus erythematosus ( SLE). Most studies have reported that mean bone mineral density is signific antly reduced in premenopausal SLE patients as compared to controls and 12- 25% of premenopausal SLE patients are considered to have osteoporosis. SLE patients have a 5-fold probability of sustaining a fracture as compared to the normal population. Causes of bone loss in SLE include the deleterious e ffects of long-term glucocorticoids and immunosuppressive drugs on the skel eton, but there is good evidence that the disease per se can lead to reduce d bone mass through several mechanisms such as reduced motility, renal impa irment, endocrine dysfunctions and the systemic effect of bone-resorbing cy tokines. Strategies to counteract bone loss in these patients must be appli ed soon after the disease onset and include effective treatment of the unde rlying disease, use of the lowest steroid dosages possible, and the prevent ion and treatment of glucocorticoid-induced osteoporosis. Available data su ggest that postmenopausal women at risk for osteoporosis may benefit from h ormone replacement therapy without experiencing further disease flares.