Background: Osteoporosis is an emerging problem which adversely affects patients with autoimmune rheumatic diseases. Several population-based studies demonstrated a higher prevalence of osteopenia and osteoporotic fracture among patients with SLE [1, 2]. Several factors are associated with detrimental effect on the osseus tissue in SLE such as female gender, sun protection strategy related vitamin D deficiency, compromised 1-25 hydroxylation of vitamin D in lupus nephritis, prolonged corticosteroid therapy etc. This study was aimed to evaluate the prevalence and risk factors for low bone mineral density (BMD) in young patients (less than 50 years) with SLE in the Indian population.

Objectives: 1. To assess the prevalence and risk factors for low BMD in young patients with SLE in the Indian population. 2. We aim to compare FRAX and BMD according to the WHO criteria to determine the high-risk groups who require osteoporotic treatment.

Methods: This was a cross-sectional retrospective observational study conducted in 10 centres across India studying the bone health in young patients (less than 50 years) with SLE. BMD was measured by dual-energy X-ray absorptiometry, and the fracture risk was calculated with FRAX tool with and without BMD to identify patients with high risk of osteoporotic fractures. A standardized questionnaire is designed to collect data including demographics, significant medical history, risk factors for secondary, corticosteroid dosage, DXA results, and FRAX assessment scores. Anonymised data were collected through a centralised portal of entry and subsequently analysed to provide relevant metrics.

Results: A total of 224 young SLE patients data were finally analysed. We observed female predominance (96.6%) and the mean age was 36.67 years (range 13–64). Osteoporosis, by WHO criterion, was detected in 63 (28.12 %) of patients. A point-biserial correlation between high SLEDAI scores and low BMD was found to be insignificant (r = 0.1294, p = 0.1144). Only 72 (32.14%) SLE patients could have FRAX assessment, highlighting the limitations of fracture risk evaluation in young patients less than 40 years. The proportion of patients with high-risk for osteoporotic fractures or reaching intervention threshold at 50 years were 34(15.17%). We observed a positive correlation between high risk of major osteoporotic fractures, hip fractures (FRAX scores) and low BMD, (r = 0.3813, p = 0.0018), (r = 0.3851, p = 0.0009) respectively. Eighteen (8.03%) patients with osteoporosis did not receive calcium or vitamin D supplementation at the time of diagnosis. Eighty six (38.39%) and 125(55.8%) of patients received calcium and Vitamin D supplementation respectively below the recommended daily allowances. A total of 36 (16.7%) patients were exposed to bisphosphonate therapy including Alendronate(17), Ibandronate(4), Risedronate(6), Zoledronate(9), and 13, 3, 4, and 8 patients were detected with low BMD, respectively. Overall, 44% of the patients received recommended treatment. Fragility fracture was reported in 4(2.6%) patients, 2 of whom had nephritis, showing a significant association (Cramér’s V: 0.1657, p = 0.042). On multivariate logistic analysis, cumulative dose of glucocorticoid (OR 1.16) were associated with high-risk by the FRAX with BMD. However, lupus nephritis and other risk factors were not associated with osteoporosis by the WHO criteria in our patients.

Conclusion: This is the first study evaluating the prevalence of low BMD in young patients with SLE in India. Low BMD was observed in 28.12% of patients. In SLE, nephritis and higher cumulative dose of glucocorticoids may contribute to elevated fracture risk. Several unmet needs were identified such as growing awareness of low BMD, suboptimal assessment of bone health and fracture risk assessment, insuffiicient bone protection strategies in young SLE population in India.

REFERENCES: [1] Bultink I.E., Lems W.F. Systemic lupus erythematosus and fractures. RMD Open. 2015;1.

[2] Bultink I.E., Lems W.F., Kostense P.J., Dijkmans B.A., Voskuyl A.E. Prevalence of and risk factors for low bone mineral density and vertebral fractures in patients with systemic lupus erythematosus. Arthritis Rheum. 2005;52:2044–2050.

Acknowledgements: NIL.

Disclosure of Interests: None declared.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.