Yang Jiwon, Park Youngjae, Lee Jennifer Jooha, Kwok Seung-Ki, Ju Ji Hyeon, Kim Wan-Uk, Park Sung-Hwan
Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
Lupus Sci Med. 2025 Jan 22;12(1):e001438. doi: 10.1136/lupus-2024-001438.
Osteoporosis is a common comorbidity in patients with SLE, and bone loss in patients with SLE has a multifactorial aetiology. This study aimed to evaluate the therapeutic efficacy of denosumab in patients with SLE with osteoporosis and to analyse the factors influencing therapeutic efficacy.
A total of 166 patients with SLE with osteoporosis who initiated denosumab between January 2016 and December 2023 were included. Changes in the T-score and areal bone mineral density (BMD) at the lumbar spine, total hip and femur neck from denosumab initiation to 12 months were measured. Correlation analysis was performed between the degree of BMD improvement and covariates including SLE-specific factors such as SLE duration, SLE Disease Activity Index 2000 (SLEDAI-2K) score, glucocorticoid dose and hydroxychloroquine use. Multiple linear regression analysis was conducted to identify predictors of the therapeutic efficacy of denosumab.
Denosumab significantly increased BMD and decreased bone turnover markers at 12 months compared with baseline. The degree of BMD improvement revealed a significant negative correlation with SLEDAI-2K score, hydroxychloroquine use, prior osteoporosis treatment and baseline BMD values. In contrast, body mass index and c-telopeptide of collagen type 1 levels were positively correlated with the degree of BMD improvement. Higher baseline BMD values, SLEDAI-2K scores and hydroxychloroquine use were significant predictors of attenuated BMD improvement.
Our study suggests that denosumab is an effective treatment option for osteoporosis in patients with SLE. The therapeutic efficacy of denosumab can be predicted by baseline BMD values, SLEDAI-2K scores and hydroxychloroquine use.
骨质疏松症是系统性红斑狼疮（SLE）患者常见的合并症，SLE患者的骨质流失具有多因素病因。本研究旨在评估地诺单抗对SLE合并骨质疏松症患者的治疗效果，并分析影响治疗效果的因素。
纳入2016年1月至2023年12月期间开始使用地诺单抗的166例SLE合并骨质疏松症患者。测量从开始使用地诺单抗至12个月时腰椎、全髋和股骨颈的T值和面积骨密度（BMD）变化。对BMD改善程度与协变量进行相关性分析，协变量包括SLE病程、SLE 2000疾病活动指数（SLEDAI-2K）评分、糖皮质激素剂量和羟氯喹使用情况等SLE特异性因素。进行多元线性回归分析以确定地诺单抗治疗效果的预测因素。
与基线相比，地诺单抗在12个月时显著增加了BMD并降低了骨转换标志物。BMD改善程度与SLEDAI-2K评分、羟氯喹使用情况、既往骨质疏松症治疗及基线BMD值呈显著负相关。相比之下，体重指数和Ⅰ型胶原C端肽水平与BMD改善程度呈正相关。较高的基线BMD值、SLEDAI-2K评分和羟氯喹使用是BMD改善减弱的显著预测因素。
我们的研究表明，地诺单抗是SLE患者骨质疏松症的有效治疗选择。地诺单抗的治疗效果可通过基线BMD值、SLEDAI-2K评分和羟氯喹使用情况来预测。
