The effect of long-term low dose prednisone on bone mineral density in patients with systemic lupus erythematosus / 中华内科杂志

ABSTRACT

Objective To investigate the effect of long-term low dose prednisone administration on bone mineral density (BMD) in patients with inactive systemic lupus erythematosus (SLE).Methods A total of 118 inactive female SLE patients with long-term administration of low dose prednisone were recruited from the Department of Rheumatology and Immunology at An hui Provincial Hospital.All patients were given low dose prednisone for long-term (≤ 10 mg/d,more than half a year).According to prednisone doses,subjects were divided into two groups,namely group A (≤7.5 mg/d) and group B (7.5-10 mg/d).In addition,patients were also divided into four groups based on the duration of administration,including group Ⅰ ≤3 years,Ⅱ from 4-5 years,Ⅲ 6-10 years and Ⅳ ＞ 10 years.Twenty-nine healthy people were recruitedas normal controls.The BMD was measured by dual energy X-ray absorptiometry.The association of BMD with prednisone dose and duration was compared between different groups.Results The incidencc of osteopenia in all patients with SLE was 42.4％ (50/118),and the incidence of osteoporosis was 14.4％ (17/118).BMD of all bone sites in both group A and B were significantly lower than that in normal control group (P ＜ 0.05).Similarly,the BMD of all bone sites in group Ⅰ,Ⅱ,Ⅲ and Ⅳ were significantly decreased (P ＜ 0.05).What needed to be stressed was the BMD in group Ⅳ was lower than those in other three groups (P ＜ 0.05).Multiple logistic regression analysis showed that the cumulative prednisone dose was the risk factor for osteopenia,while taking calcium and alfacalcidol were protective factors.Conclusion Long-term use of low dose prednisone result in the decrease of BMD in patients with inactive SLE.The lumbar spine and femoral neck had more severe osteopenia.Long-term administration of prednisone,even less than 7.5 mg/d,can also cause osteopenia.Calcium and alfacalcidol were protective factors of BMD.