Abstract
BackgroundObservational studies have indicated a high but heterogeneous prevalence of low bone mineral density (BMD) and vertebral fractures (VF) in patients with systemic lupus erythematosus (SLE). Therefore, the objectives of this systematic review and meta-regression were: 1) to compare BMD between SLE patients and healthy controls and 2) to evaluate the relationship between BMD and glucocorticoid therapy and VF in SLE patients.Methods and findingsArticles were identified from electronic databases (PubMed, Embase, VHL, SciELO and the Cochrane Library). Prospective longitudinal and cross-sectional studies were considered for review. We evaluated the quality of the evidence included using the Oxford Centre for evidence-based medicine (EBM) Levels of Evidence. In total, 38 articles were identified and analyzed (3442 SLE cases and 6198 controls) in the analysis of BMD (9232 women and 408 men). There were significant differences in mean BMD between SLE patients and controls. BMD mean difference in cases/controls: -0.0566 95% CI (-0.071, -0.0439; p = < 0.0001). When only SLE patients were analyzed, the BMD did not significantly differ between patients who had or had not received glucocorticoid (GCT) therapy. 694 SLE patients were included in the analysis of VF (189 with VF vs. 505 without VF). Patients with VF had lower BMD than patients without VF (BMD mean difference without VF/with VF: 0.033 (95%CI: 0.006–0.060); p-value: 0.0156).ConclusionsPatients with SLE had lower BMD than healthy controls. Moreover, SLE patients with VF had lower BMD than patients without VF. However, our data did not show that GCT therapy had an impact on BMD.
Highlights
Observational studies have indicated a high but heterogeneous prevalence of low bone mineral density (BMD) and vertebral fractures (VF) in patients with systemic lupus erythematosus (SLE)
Our data did not show that GCT therapy had an impact on BMD
Osteoporosis and fractures contribute to damage in the musculoskeletal system, which is frequently involved in patients with SLE [5]
Summary
Methods and findingsArticles were identified from electronic databases (PubMed, Embase, VHL, SciELO and the Cochrane Library). 38 articles were identified and analyzed (3442 SLE cases and 6198 controls) in the analysis of BMD (9232 women and 408 men). There were significant differences in mean BMD between SLE patients and controls. A systematic literature review was conducted using the following electronic databases: PubMed (1946-Week 2, January 2018), Cochrane library (1985-Week 2, Week 2, January 2018), EMBASE (1974-Week 2, January 2018), Virtual Health Library (VHL) (1998-Week 2, January 2018), and SciELO (1997-Week 2, January 2018), for published studies. Due to the diversity of studies found, three meta-regression analyses were made: The first aimed to assess possible differences in BMD between SLE cases and controls. The following strategy was employed in order to obtain a final, most parsimonious model in each case: first, the variance component structure was obtained by fitting several models with a saturated fixed-effects structure (all relevant covariates plus full interactions) and different variance models (fixed effects, mixed effects and multilevel mixed-effects). I2 values of 25%, 50%, and 75% were qualitatively classified as low, moderate, and high respectively
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