Kipen Y, Briganti E, Strauss B, Will R, Littlejohn G, Morand E
Monash Medical Centre Rheumatology Unit, Clayton, Victoria, Australia.
J Rheumatol. 1999 Feb;26(2):310-7.
To measure the change in bone mineral density (BMD, g/cm2) in a female population with systemic lupus erythematosus (SLE) over 3 years, to identify factors predictive of bone loss, including the role of corticosteroid and disease related variables, and to determine the predictive value of urinary collagen crosslinks for bone loss.
All premenopausal women with SLE who participated in a cross sectional study of BMD in 1994 were invited to undergo a standardized interview, examination, medical record review, and BMD measurement of the lumbar spine and femoral neck by dual energy x-ray absorptiometry.
Thirty-two women participated with a mean (SEM) age of 35.2 (1.5) years, duration of SLE of 7.0 (0.8) years, and mean (range) time to followup of 3.2 (2.9-3.4) years. Twenty-one subjects were exposed to corticosteroids during the study period with a mean (range) daily dose of prednisolone of 11.1 (2.8-22.9) mg. There was no significant change over the 3 years in BMD at the lumbar spine (1.161+/-0.122 vs. 1.169+/-0.022; p = 0.39) or femoral neck (0.944+/-0.023 vs. 0.955+/-0.020; p = 0.47) for the group as a whole, or when subjects were divided according to corticosteroid exposure. However, in the corticosteroid exposed subgroup, patients treated with > or = 7.5 mg/day (n = 14) lost lumbar spine BMD (-0.50%/yr) in contrast to those receiving <7.5 mg/day, who gained 1.06%/yr (p = 0.02). Furthermore, no participant receiving <7.5 mg/day lost lumbar spine BMD, while 57% of patients receiving > or =7.5 mg/day lost lumbar spine BMD (p = 0.01). In the corticosteroid exposed subgroup only, subjects who did not exercise regularly lost femoral neck BMD, while those who did gained femoral neck BMD (-0.54%/yr vs. 1.39%/yr; p = 0.02). Disease related variables (disease severity, activity, duration, functional capacity) and baseline urinary collagen crosslink levels were not predictive of BMD change.
Loss of lumbar spine and femoral neck BMD in this premenopausal female SLE population was minimal for the group as a whole; however, a daily dose of prednisolone of > or =7.5 mg was associated with loss of lumbar spine BMD. In corticosteroid exposed patients, regular exercise was protective of femoral neck BMD loss. A single baseline measurement of urinary collagen crosslinks was not predictive of bone loss.
测量系统性红斑狼疮（SLE）女性人群3年内骨矿物质密度（BMD，g/cm²）的变化，确定骨量丢失的预测因素，包括皮质类固醇和疾病相关变量的作用，并确定尿胶原交联物对骨量丢失的预测价值。
邀请所有参加1994年BMD横断面研究的绝经前SLE女性进行标准化访谈、检查、病历审查，并通过双能X线吸收法测量腰椎和股骨颈的BMD。
32名女性参与研究，平均（标准误）年龄为35.2（1.5）岁，SLE病程为7.0（0.8）年，平均（范围）随访时间为3.2（2.9 - 3.4）年。21名受试者在研究期间接受皮质类固醇治疗，泼尼松龙平均（范围）日剂量为11.1（2.8 - 22.9）mg。整个组在3年内腰椎（1.161±0.122 vs. 1.169±0.022；p = 0.39）或股骨颈（0.944±0.023 vs. 0.955±0.020；p = 0.47）的BMD无显著变化，根据皮质类固醇暴露情况分组时也无显著变化。然而，在皮质类固醇暴露亚组中，接受≥7.5 mg/天治疗的患者（n = 14）腰椎BMD丢失（-0.50%/年），而接受<7.5 mg/天治疗的患者腰椎BMD增加1.06%/年（p = 0.02）。此外，接受<7.5 mg/天治疗的参与者无一例腰椎BMD丢失，而接受≥7.5 mg/天治疗的患者中有57%腰椎BMD丢失（p = 0.01）。仅在皮质类固醇暴露亚组中，不经常锻炼的受试者股骨颈BMD丢失，而经常锻炼的受试者股骨颈BMD增加（-0.54%/年 vs. 1.39%/年；p = 0.02）。疾病相关变量（疾病严重程度、活动度、病程、功能能力）和基线尿胶原交联水平不能预测BMD变化。
该绝经前女性SLE人群整体腰椎和股骨颈BMD丢失极少；然而，泼尼松龙日剂量≥7.5 mg与腰椎BMD丢失有关。在接受皮质类固醇治疗的患者中，规律锻炼可预防股骨颈BMD丢失。单次基线尿胶原交联物测量不能预测骨量丢失。
