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Journal of Peking University(Health Sciences) ›› 2018, Vol. 50 ›› Issue (6): 998-1003. doi: 10.19723/j.issn.1671-167X.2018.06.010

• Article • Previous Articles     Next Articles

Study of bone mineral density and serum bone turnover markers in newly diagnosed systemic lupus erythematosus patients

Hai-hong YAO1,Su-mei TANG1,Zhi-min WANG1,Xia ZHANG1,Xu-yong CHEN1,Li GAO1,Jing LIU1,Yi-jun DAI1,Zhao-heng HU2,Xue-wu ZHANG(),Zhan-guo LI1   

  1. 1. Department of Rheumatology and Immunology, 2. Department of Endocrinology, Peking University People’s Hospital,Beijing 100044, China
  • Received:2018-08-27 Online:2018-12-18 Published:2018-12-18
  • Contact: Xue-wu ZHANG E-mail:xuewulore@163.com
  • Supported by:
    Supported by the National Natural Science Foundation of China(81801618)

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Abstract:

Objective: To investigate the changes of bone mineral density (BMD) and serum bone turnover factor in newly diagnosed systemic lupus erythematous (SLE) patients.Methods:Eighty newly diagnosed SLE patients and 80 age and gender matched healthy controls were enrolled. None of the SLE patients had ever received glucocorticoid,immunosuppressive agents or vitamin D. BMD was measured at radius,lumbar spine and hip by dual X ray absorptiometry (DXA). Bone turnover markers including se-rum levels of tartrate-resistant acid phosphatase 5b (TRAP5b),bone alkaline phosphatase (BAP) and 25-hydroxy vitamin D3 (25-OH-VD3) were measured by enzyme-linked immunosorbent assay (ELISA). Logistic regression was employed to analyze the risk factors associated with decreased BMD.Results:Mean age of the SLE patients was (32.8±12.4) years,and 85% were female,none of whom were post-menopausal. BMD was significantly reduced in all the measured sites,compared with the healthy controls. Sixteen (20%) of the patients were osteopenic in at least one site measured locations. The serum levels of 25-OH-VD3 were markedly reduced in the newly diagnosed SLE patients than those of the normal controls [(46.1+12.3) nmol/L vs. (25.4+11.2) nmol/L,P<0.001)]. The serum levels of 25-OH-VD3 in the SLE patients with nephritis were much lower than those without nephritis (P=0.04). A significant negative correlation was demonstrated between the serum concentration of 25-OH-VD3 and the disease activity scores as measured by SLE disease activity index (SLEDAI) (r=-0.3,P=0.001). The serum TRAP5b concentration was positively correlated with SLEDAI (r=0.435,P=0.003). Age (P=0.058) and SLEDAI (P=0.085) were probably associated with decreased BMD in Logistic regression analysis.Conclusion:The study showed reduced BMD in untreated SLE patients. The role of chro-nic inflammation was of probable importance in bone metabolism.

Key words: Lupus erythematosus,systemic, Bone density, Bone turnover markers

CLC Number: 

  • R593.241

Table 1

Baseline demographic data of newly diagnosed SLE patients and gender- and age-matched controls"

Items SLE patients (n=80) Health control (n=80) P value
Age/years, x-±s 32.8±12.4 30.2±4.5 0.08
Females, n (%) 68 (85) 70 (87.5) 0.82
Postmenopause of woman, n (%) 0 0
Bodymass index/(kg/m2), x-±s 22.1±2.9 21.3±3.0 0.07
Ever smoking, n (%) 2 (2.4) 0 0.5
Disease duration/months,median (P25, P75) 7 (2, 22.5)
SLEDAI score, x-±s 16±8
Vitamin intake/(μg/d) 0 0

Table 2

Baseline bone mineral density data of newly diagnosed SLE patients and gender- and age-matched health controls"

Items Bone mineral density/(g/cm2), x-±s P value
SLE patients (n=80) Health control (n=80)
Lumbar spine
Total 0.929±0.143 1.008±0.107 <0.001
L1 0.892±0.116 0.917±0.102 0.150
L2 0.966±0.105 1.010±0.112 0.011
L3 0.978±0.131 1.047±0.111 <0.001
L4 0.985±0.162 1.039±0.121 0.018
Hip
Total hip 0.901±0.130 0.939±0.107 0.045
Neck 0.801±0.136 0.792±0.096 0.629
Ward’s triangle 0.773±0.165 0.747±0.121 0.256
Intertrochanter 1.130±0.098 1.125±0.126 0.779
Trochanter 0.712±0.102 0.701±0.097 0.486
Radius (Left) 0.692±0.058 0.701±0.058 0.034

Figure 1

Bone metallic status of newly diagnosed SLE patients and health control (n=80)SLE, systemic lupus erythematosus; HC, health control; 25-OH-VD3, 25-dihydroxy-vitamin D3; TRAP5b, tartaric acid phosphatase 5b; BAP, bone alkaline phosphatase."

Figure 2

Correlation of serum 25-OH-VD3 concentration to disease activity,serological features and organ injury in SLE patients 25-OH-VD3, 25-dihydroxy-vitamin D3; SLEDAI,systemic lupus erythematous disease activity index;dsDNA,double-stranded DNA;APL,anti-phospholipid antibody;LN,lupus nephritis;C3,complement C3;C4,complement C4."

Table 3

Logistic regression analyses of risk factors of decreased bone mineral density among newly diagnosed SLE patients"

Risk factors B SE P value OR (95%CI)
Age 0.026 0.023 0.249 1.027 (0.981,1.074)
Disease duration 0.041 0.022 0.058 1.042 (0.999,1.087)
Gender -0.678 0.956 0.478 0.508 (0.078,3.303)
SLEDAI 0.073 0.042 0.085 1.076 (0.990,1.169)
TRAP5b 0.173 0.242 0.475 1.189 (0.74,1.909)
BAP -0.004 0.046 0.926 0.996 (0.910,1.089)
25-OH-VD3 -0.054 0.508 0.187 0.948 (0.875,1.026)
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