Abstract

FERNANDEZ-CODINA, Andreu  and  POPE, Janet E.. Osteoporosis and osteonecrosis in systemic lupus erythematosus. Rev.Colomb.Reumatol. [online]. 2021, vol.28, suppl.1, pp.3-11.  Epub Feb 12, 2022. ISSN 0121-8123.  https://doi.org/10.1016/j.rcreu.2021.02.005.

Half of the patients with systemic lupus erythematosus (SLE) will have a reduced bone density and more than one in ten will develop osteoporosis (OP) prematurely. Multiple risk factors have been related to loss of bone mass, but just a few are modifiable, such as adequate vitamin D and calcium intakes, weight bearing exercise, controlling SLE activity and limiting the use of glucocorticoids (GC). GC have also been strongly associated to osteonecrosis or avascular necrosis (AVN). The main consequences of OP and AVN are fractures, which lead to significant functional limitation, loss of quality of life and increased morbidity. OP-related fractures can be reduced by performing appropriate screening with bone densitometries and providing prophylactic treatment when long-term or high dose GC are needed. No formal screening is available for AVN; but diagnosis is made by imaging (X-ray, bone scan or advanced imaging where appropriate). Aiming for the lowest dose possible of GC in combination with immunosuppression as well as an early recognition of the symptoms will prevent further complications. This manuscript is a practical review of the epidemiology, pathophysiology, and management of OP and AVN in patients with SLE, based on the available evidence and guidelines.

Keywords : Systemic lupus erythematosus; Osteoporosis; Osteonecrosis; AVN; Avascular necrosis; Fracture; SLE; Lupus; Glucocorticoids; Antiphospholipid antibodies; Renal failure.

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