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Osteoporosis causing fractures is a common complication of systemic lupus erythematosus (SLE), commonly known as lupus. But many of these fractures can be prevented.

Fragility fractures are a common complication of lupus (systemic lupus erythematosis, or SLE). Even children, men, and women who have not reached menopause, along, of course, with women who have passed menopause are at risk of low-impact broken bones if they have lupus. It is essential to take steps to preserve bone mineral density before fractures occur. But some essential knowledge can help people who have lupus stay ahead of brittle bone disease.

Here are five things people who have lupus need to know about bone health.

1. By the age of 50, most people who have lupus have developed a "pre-osteoporosis" condition called osteopenia

A DXA test measures bone mineral density and the propensity for fragility fractures, broken bones that "just happen" without high impact. In one study of people who had been diagnosed with lupus for an average of 22 years and who were an average age 49, more than half had substantially reduced bone mineral density. In people with lupus, osteoporosis tends to show up in the spine first. They may lose height as compression fractures shorten the spine and experience inexplicable lower back pain. Breaks in the hip and wrist are usually a later risk of the disease.

2. The majority of people who have lupus are deficient in vitamin D

One study found that 79 percent of lupus patients have a history of vitamin D deficiency. The intestines cannot absorb calcium from food and supplements without vitamin D, and the parathyroid glands will send out hormones to "steal" calcium from bone when vitamin D levels are low. Supplementing with 1,000 IU or more (up to 5,000 IU) vitamin D daily is a good idea for most people who have lupus.

3. Treatment with corticosteroid medications often leads to osteoporosis of the spine

Investigators working with one group of SLE patients found that 50 percent who received corticosteroid medications had substantial loss bone mass and 28 percent had osteopenia or osteoporosis. Glucocorticoid (steroid) medications for lupus include methylprednisone (DepoMedrol, Medrol, Medrol Dosepak, ​ SoluMedrol, A-Methapred) and prednisone (Deltasone,  Prednisone Intensol, Rayos, Sterapred, Sterapred DS).

These medications fight the autoimmune reactions that cause the symptoms of SLE. The worse the lupus gets, the more of these drugs the doctor prescribes. The problem is that any dose of more than 15 mg a day for six months will cause loss bone strength in almost any patient at almost any age, even children. The effects of these drugs are cumulative. The longer you have been taking them, the weaker your spine will be. (There isn't a clear-cut relationship between the use of these medications and osteoporosis in other bones.) Signs that taking these medications has caused bone loss are loss of height (you are shorter in middle age than you were as a young adult) and back pain.

4. People who have lupus who also get medications for epilepsy have extra risk for weak bones

The relationship between antiseizure medications and osteoporosis isn't as strong as the relationship between corticosteroid drugs and osteoporosis if you have SLE, but it's significant and substantial. If you take seizure medication, you need to pay attention to bone health.

5. If you have lupus, you need to discuss bone health concerns with your doctor and take preventative steps to stop fractures before they occur

People who have lupus have a lot of things to discuss with their doctors, but bone health is essential to an active life. There are simple steps anyone at any age of any gender needs to stave off osteoporosis:

  • Supplements. Especially if you are taking corticosteroids (methylprednisone or prednisone in any of their brand name forms), you need to be sure you are getting the calcium and vitamin D you need by taking supplements every day. Getting 1000 to 1500 mg of calcium (in two or three doses of not more than 500 mg each) and 1000 IU of vitamin D every day will not guarantee that you won't get fractures, but just these two simple supplements reduce your risk of fractures about 40 percent. Better, make sure you get magnesium (200 to 600 mg per day) and vitamin K2 (45 mg per day) to help your body use calcium for better bones.
  • Safety. People who have lupus tend to break bones. The bones of the spine are weakest, but fractures of the vertebrae don't usually occur as the result of some impact you can prevent. Fractures of the hip and wrist, however, are preventable. The kind of fall that is most likely to cause a broken hip is a fall side to side. Be careful getting out of a car. Use handrails. The kind of fall that is most likely to cause a broken wrist is sticking out the hands to break a fall. When you feel weak, use a walker. It's better to sit down than to fall down.
  • Surveillance. Osteoporosis will show up in the spine first. If you have unexplained low back pain, see your doctor. Discovering osteoporosis of the spine as soon as possible allows for treatments that may prevent other, more debilitating fractures later.

  • Carli L, Tani C, Spera V, Vagelli R, Vagnani S, Mazzantini M, Di Munno O, Mosca M. Risk factors for osteoporosis and fragility fractures in patients with systemic lupus erythematosus. Lupus Sci Med. 2016 Jan 19.3(1):e000098. doi: 10.1136/lupus-2015-000098. eCollection 2016. PMID: 26848397.
  • Chan PC, Yu CH, Yeh KW, Horng JT, Huang JL. Comorbidities of pediatric systemic lupus erythematosus: A 6-year nationwide population-based study. J Microbiol Immunol Infect. 2016 Apr 49.2):257-63. doi: 10.1016/j.jmii.2014.05.001. Epub 2014 Jul 24. PMID: 25066707
  • Stefanidou S, Gerodimos C, Benos A, Galanopoulou V, Chatziyannis I, Kanakoudi F, Aslanidis S, Boura P, Sfetsios T, Settas L, Katsounaros M, Papadopoulou D, Giamalis P, Dombros N, Chatzistilianou M, Garyfallos A. Clinical expression and course in patients with late onset systemic lupus erythematosus. Hippokratia. 2013 Apr
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  • Photo courtesy of SteadyHealth

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