1955 Tang, et al: Organ damage and SLE Personal non-commercial use only. The Journal of Rheumatology Copyright © 2012. All rights reserved. Increased Organ Damage Associated with Deterioration in Volumetric Bone Density and Bone Microarchitecture in Patients with Systemic Lupus Erythematosus on Longterm Glucocorticoid Therapy XIAO LIN TANG, TRACY YANER ZHU, VIVIAN W. HUNG, LING QIN, CHUN-KWOK WONG, EMILY W. KUN, LAI SHAN TAM, and EDMUND K. LI ABSTRACT. Objective. To evaluate bone quality in patients with systemic lupus erythematosus (SLE) who were undergoing longterm glucocorticoid (GC) therapy, and to focus on the correlation between bone quality and organ damage. Methods. Seventy-eight female patients with SLE and organ damage taking longterm GC, and 72 age-matched SLE patients without damage taking longterm GC were recruited for study. Clinical variables of interest included disease activity, cumulative organ damage (by Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index; SDI), major organ involvement (musculoskeletal damage and neuropsychiatric damage, etc.), and use of medication. Areal bone mineral density (aBMD) was measured by dual-energy X-ray absorptiometry. Bone geometry, volumetric BMD (vBMD), microarchitecture, and biomechanical properties were measured by high-resolution peripheral quantitative computed tomography (HR-pQCT). Results. Patients were mean age of 45 years (SD 10) and 54% were postmenopausal. The median SDI score of the cohort was 1 (interquartile range 1-2, range 1-5). Compared with patients without damage, the prevalence of osteopenia at either total hip or lumbar spine was significantly higher, and there were trends of deterioration of bone geometry, vBMD, microarchitecture, and biomechanical properties in patients with organ damage. Potential risk factors for bone quality in patients with damage were screened by univariate analysis. During multiple regression analysis, SDI was the only clinical variable consistently associated with deterioration of vBMD and microarchitecture. Conclusion. Cumulative organ damage consistently correlated with deterioration of vBMD and bone microarchitecture in SLE patients with damage on longterm GC therapy. HR-pQCT provides an insight into the underlying mechanism of bone loss in SLE. (First Release Aug 15 2012; J Rheumatol 2012;39:1955–63; doi:10.3899/jrheum.120213) Key Indexing Terms: BONE MICROARCHITECTURE SYSTEMIC LUPUS ERYTHEMATOSUS ORGAN DAMAGE HIGH-RESOLUTION PERIPHERAL QUANTITATIVE COMPUTED TOMOGRAPHY From the Department of Medicine and Therapeutics, Department of Orthopedics and Traumatology, and Department of Chemical Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong; and Department of Medicine and Geriatrics, Tai Po Hospital, Hong Kong. Supported by a grant from the Research Grants Council of the Hong Kong Special Administrative Region, China (Project no. CUHK471010). X.L. Tang, MMS; T.Y. Zhu, PhD, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong; V.W. Hung, MPhil; L. Qin, PhD, Department of Orthopedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong; C-K. Wong, PhD, Department of Chemical Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong; E.W. Kun, MBBS, FRCP, Department of Medicine and Geriatrics, Tai Po Hospital; L.S. Tam, MD; E.K. Li, MD, FRCP(C), Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong. Address correspondence to Prof. E.K. Li, Department of Medicine and Therapeutics, 9/F, Clinical Science Building, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, NT, Hong Kong. E-mail: edmundli@cuhk.edu.hk Accepted for publication July 3, 2012. Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with a broad range of clinical and laboratory presentations involving almost all organs, including the neuropsychiatric, cardiovascular, and muscu- loskeletal systems. Women with SLE have higher risk of osteoporosis and fracture than the general population as a result of exposure to direct or indirect risk factors, such as treatment with glucocorticoid (GC), sun avoidance, or premature menopause caused by the disease itself or its treatment with cytotoxic drugs 1 . Prevalence of osteoporosis in Chinese patients with SLE ranged from 4% to 6% in premenopausal patients 2 and 3% to 48% in postmenopausal patients 3 , depending on different measurement sites. Many studies using dual-energy X-ray absorptiometry (DEXA) have shown that cumulative organ damage of SLE is a risk factor for decreased areal bone mineral density www.jrheum.org Downloaded on February 17, 2022 from