Department of Medicine, Tuen Mun Hospital, New Territories, Hong Kong, SAR, China.
Rheumatology (Oxford). 2012 Mar;51(3):468-75. doi: 10.1093/rheumatology/ker306. Epub 2011 Nov 16.
To study the BMD of patients with SLE according to the age of disease onset.
Consecutive SLE patients were screened for BMD at the hip, lumbar spine and whole body by the dual-energy X-ray absorptiometry (DXA). Comparison was made between patients who had disease onset in childhood (<18 years) and adulthood (≥18 years). Factors associated with low BMD were studied by linear regression.
A total of 395 SLE patients were studied (94% women; 11% childhood-onset disease). Osteoporosis of the lumbar spine and the hip/femoral neck was present in 20 and 10% of the patients, respectively. Childhood-onset SLE patients were less likely to be post-menopausal, but had significantly lower BMI, longer SLE duration and a higher frequency of ever use of high-dose CSs, CYC and AZA. Despite a significantly younger age, the BMD of the hip, femoral neck and lumbar spine was significantly lower in childhood- than adult-onset SLE patients. In linear regression models, childhood-onset disease was an independent factor for lower BMD at the lumbar spine (β = -0.18; P = 0.002), hip (β = -0.20; P = 0.001) and femoral neck (β = -0.16; P = 0.01) after adjustment for age, sex, BMI, smoking, menopause, SLE duration and damage index, duration and current dose of prednisolone treatment and the ever use of high-dose glucocorticoids, other immunosuppressive agents, calcium, vitamin D and the bisphosphonates.
In adult SLE patients, childhood-onset disease carries a higher risk of osteoporosis, which may possibly be related to a higher cumulative dose of glucocorticoids used for more active disease and failure to achieve a normal peak bone mass during puberty.
根据发病年龄研究系统性红斑狼疮（SLE）患者的骨密度（BMD）。
采用双能 X 射线吸收法（DXA）对连续的 SLE 患者进行髋部、腰椎和全身 BMD 筛查。比较发病年龄在儿童期（<18 岁）和成年期（≥18 岁）的患者。通过线性回归研究与低 BMD 相关的因素。
共研究了 395 例 SLE 患者（94%为女性；11%为儿童发病）。分别有 20%和 10%的患者存在腰椎和髋部/股骨颈骨质疏松症。儿童发病的 SLE 患者更不可能处于绝经后状态，但 BMI 显著较低，SLE 病程更长，且更频繁地使用高剂量皮质类固醇、环磷酰胺和阿扎胞苷。尽管年龄明显较小，但与成年发病的 SLE 患者相比，儿童发病的 SLE 患者髋部、股骨颈和腰椎的 BMD 显著更低。在线性回归模型中，在调整年龄、性别、BMI、吸烟、绝经、SLE 病程和损伤指数、泼尼松治疗的持续时间和当前剂量以及是否使用高剂量糖皮质激素、其他免疫抑制剂、钙、维生素 D 和双膦酸盐后，儿童发病是腰椎（β=-0.18；P=0.002）、髋部（β=-0.20；P=0.001）和股骨颈（β=-0.16；P=0.01）BMD 较低的独立因素。
在成年 SLE 患者中，儿童发病的疾病具有更高的骨质疏松症风险，这可能与更积极的疾病中使用更高累积剂量的皮质类固醇以及青春期未能达到正常峰值骨量有关。
