The Lupus-Osteoporosis Link
From the National Institutes of Health's Osteoporosis and Related Bone Diseases - National Resource Center
Studies have found an increase in bone loss and fracture in individuals with systemic lupus erythematosus (SLE). In fact, women with lupus may be nearly five times more likely to experience a fracture from osteoporosis.
Individuals with lupus are at increased risk for osteoporosis for many reasons. To begin with, the glucocorticoid medications often prescribed to treat SLE can trigger significant bone loss. In addition, pain and fatigue caused by the disease can result in inactivity, further increasing osteoporosis risk. Studies also show that bone loss in lupus may occur as a direct result of the disease. Of concern is the fact that 90 percent of the individuals affected with lupus are women, a group already at increased osteoporosis risk.
Osteoporosis Management Strategies
Strategies for the prevention and treatment of osteoporosis in people with lupus are not significantly different from the strategies for those who do not have the disease.
Nutrition: A well-balanced diet rich in calcium and vitamin D is important for healthy bones. Good sources of calcium include low-fat dairy products; dark green, leafy vegetables; and calcium-fortified foods and beverages. Supplements can help ensure that you get adequate amounts of calcium each day, especially in people with a proven milk allergy. The Institute of Medicine recommends a daily calcium intake of 1,000 mg (milligrams) for men and women, increasing to 1,200 mg for those age 50 and older.
Vitamin D plays an important role in calcium absorption and bone health. It is synthesized in the skin through exposure to sunlight. Food sources of vitamin D include egg yolks, saltwater fish, and liver. Many people obtain enough vitamin D naturally, excessive sun exposure can trigger flares in some people with lupus. These individuals may need vitamin D supplements to achieve the recommended intake of 400 to 600 IU (International Units) each day.
Exercise: Like muscle, bone is living tissue that responds to exercise by becoming stronger. The best exercise for your bones is weight-bearing exercise that forces you to work against gravity. Some examples include walking, climbing stairs, weight lifting, and dancing.
Exercising can be challenging for people with lupus who are affected by joint pain and inflammation, muscle pain, and fatigue. However, regular exercises such as walking can help prevent bone loss and provide many other health benefits.
Healthy lifestyle: Smoking is bad for bones as well as the heart and lungs. Women who smoke tend to go through menopause earlier, triggering earlier bone loss. In addition, smokers may absorb less calcium from their diets. Alcohol can also negatively affect bone health. Those who drink heavily are more prone to bone loss and fracture, both because of poor nutrition and an increased risk of falling.
Bone density test: A bone mineral density (BMD) test measures bone density at various parts of the body. This safe and painless test can detect osteoporosis before a fracture occurs and predict on's chances of fracturing in the future. Lupus patients, particularly those receiving glucocorticoid therapy for 2 months or more, should talk to their doctors about whether they might be candidates for a bone density test. The BMD test can help determine whether medication should be considered.
Medication: Like lupus, osteoporosis is a disease with no cure. The Food and Drug Administration has approved several medications (alendronate, risedronate, ibandronate, zoledronic acid, raloxifene, calcitonin, teriparatide, and estrogen/hormone therapy) for the prevention and/or treatment of osteoporosis in postmenopausal women. Alendronate and risedronate also are approved for use in men. For people with lupus who develop or may develop glucocorticoid-induced osteoporosis, alendronate has been approved to treat this condition and risedronate has been approved to treat and prevent it.