Charité University Medicine Berlin Berlin, Germany
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Edgar Wiebe1, Elisa Schilling2, Dörte Huscher3, Andriko Palmowski4, Zhivana Boyadzhieva5, Sandra Hermann1, Burkhard Muche1, Tobias Alexander6, Falk Hiepe5 and Frank Buttgereit1, 1Charité Universitätsmedizin, Dept. Rheumatology, Berlin, Germany, 2Charité Universitätsmedizin Berlin, Dept. Rheumatology, Berlin, Germany, 3Institute of Biometry and Clinical Epidemiology and Berlin Institute of Health, Charité Universitätsmedizin Berlin, Berlin, Germany, 4Charité - Universitätsmedizin Berlin, Berlin, Germany, 5Charité Universitatsmedizine - Berlin, Berlin, Germany, 6Charité Universiätsmedizin Berlin, Dept. Rheumatology, Berlin, Germany
Background/Purpose: Patients with systemic lupus erythematosus (SLE) are at increased risk for osteoporosis and fragility fractures. This risk is mediated by a variety of factors such as chronic inflammation, treatment with glucocorticoids (GC), vitamin D deficiency, and others. The role of disease-specific factors of SLE has not been fully elucidated. We aimed to identify factors associated with bone mineral density and osteoporosis including fragility fractures to better understand the interplay between disease-specific factors and general risk factors that drive bone loss in this patient population.
Methods: Rh-GIOP is a prospective observational cohort study investigating bone health in consecutive patients ≥18 years with inflammatory rheumatic diseases and current or prior GC treatment. This cross-sectional analysis assessed the baseline visits of all patients with SLE fulfilling the EULAR/ACR 2019 SLE classification criteria. Multivariable linear regressions models were fitted to identify factors associated with bone mineral density (BMD). As a second outcome, we investigated factors associated with clinical osteoporosis (OP, defined by either a T-Score of ≤ -2,5, anti-osteoporotic treatment and/or fragility fractures) by multivariable logistic regression analysis.
Results: Baseline data from 110 patients with SLE were analyzed. The mean age was 48.1±14.5 years, mean disease duration 16.3±9.9 years, and 41% of the cohort was identified as having OP. Lupus nephritis was present in 35% of the SLE patients, of whom 55% had active nephritic disease at baseline osteoporosis screening visit. Class IV and V accounted for most nephritis cases (61%). In multivariable linear regression analysis, lupus nephritis class IV and V (reg. coefficient (95%CI): -0.745 (-1.395;-0.095)), the presence of U1-RNP antibodies (-0.750 (-1.314;-0,187)) as well as C-reactive protein (CRP, -0.015 (-0.026;-0.003)) and longer disease duration (-0.037 (-0.056;-0.018)) were significantly associated with low BMD. Conversely, clinical remission (defined as SLEDAI-2K=0 and GC dosage ≤5 mg prednisone equivalent per day) was positively associated with BMD (0.447 (0.037;0.857)), as were Siglec-1 levels on monocytes as surrogate for Type-I interferon activity (0.558 (0.150;0.967)), BMI (0.045 (0.014;0.076)), and health assessment questionnaire (HAQ, 0.307 (0.078;0.536)). In multivariable logistic regression analysis, active lupus nephritis (OR (95%CI): 7.42 (1.256;43.868)) was strongly associated with OP in patients with SLE. Additionally, age (1.06 (1.020;1.100)), HAQ (0.29 (0.120;0.682)) and complement factor 3 (1.27 (1.002;1.601)) were found to be significantly related to the presence of OP. Neither current GC use, cumulative GC dose nor GC duration were significantly associated with BMD or clinical OP.
Conclusion: In patients with SLE, indicators of disease severity, expressed by (active) lupus nephritis, high CRP, U1-RNP antibodies, and long disease duration, are related to poor bone health in addition to commonly known risk factors such as low BMI and higher age. The knowledge of these disease-specific factors helps to identify patients with SLE at particular high risk for OP and fragility fractures.
E. Wiebe: EW reports consultancy fees, honoraria and travel expenses from Medac and Novartis., 2, 6, 12, Travel Expenses; E. Schilling: None; D. Huscher: None; A. Palmowski: None; Z. Boyadzhieva: None; S. Hermann: None; B. Muche: BM received consulting and speaker honoraria and/or congress support from UCB Pharma Germany, Amgen Germany, Stadapharm., 6, 12, congress support; T. Alexander: None; F. Hiepe: None; F. Buttgereit: AbbVie/Abbott, 6, Horizon Therapeutics, 5, Pfizer, 5, 6, Roche, 6.
