People living with systemic lupus erythematosus, or lupus, may be at increased risk for developing other health conditions. One of those is osteoporosis, or the gradual weakening of the skeleton that could lead to fractures of the hip, spine and other bones. The condition is much more common in women than men; roughly 50% of all women and 25% of men over the age of 50 will sustain an osteoporosis-related fracture in their lifetime. That’s largely the result of the loss of estrogen, an important hormone for bone growth, during menopause.
Osteoporosis is also associated with other factors, including the use of certain medications and nutritional deficiencies, particularly calcium and vitamin D.
It’s important to understand the relationship between lupus, bone health and osteoporosis, as well as ways to lower your own risks and manage osteoporosis.
Risk Factors for and Effects of Osteoporosis
Inflammation caused by lupus affects many parts of the body, including the skeleton, and contributes to the loss of bone.
Studies have found that compared to healthy women, women with lupus have an increase in the bone loss that leads to osteoporosis, including as much as a fivefold increase in the risk of a bone fracture. Women with lupus also suffer from the loss of height as well as bone around the teeth in the jaw and skull.
Additional factors putting people with lupus at an increased risk for osteoporosis include:
- use of corticosteroids or glucocorticoids, which decrease the body’s ability to absorb calcium and weaken bone mineralization
- kidney disease, which affects nearly 30% of people with lupus
- reduced physical activity due to lupus symptoms
- menopause, early menopause, or having no menstrual periods
- family history of osteoporosis
- tobacco or nicotine use in any form
- excess drinking of alcohol
Furthermore, approximately 10% of people with lupus develop a condition called avascular necrosis (also known as osteonecrosis) as a result of their use of steroids. The condition involves reduced blood supply to the bone, generally in the hips, along with increased swelling and pressure. Bone weakens, causing tiny cracks, which lead to joint pain, decreased movement within the joint and muscle spasm. At the end stage, the bone collapses under stress.
How to Lower Your Risk
There are ways to protect yourself from osteoporosis and its effects. If you have been diagnosed with osteoporosis or osteopenia, a less advanced form of bone loss that can progress to osteoporosis, your doctor may recommend a variety of medications that reduce the risk of fracture. These treatments can either slow additional loss of bone or, in some cases, even stimulate the formation of new bone. Your rheumatologist can advise you on which of these therapies is right for you.
Supplements with calcium and vitamin D can keep bones strong, as can regular weight-bearing exercise like running, hiking, walking, playing tennis or other sports. Stopping smoking and reducing your intake of alcohol also can help, as these habits are bad for bone.
For more information visit https://www.hss.edu/conditions_lupus-osteoporosis-bone-bealth.asp.
Patricia Donohue, MSN, ACNP-BC, ONP, is a nurse practitioner at the Metabolic Bone Health Center at Hospital for Special Surgery. She developed and initiated the fracture liaison service at Hospital for Special Surgery in addressing patients’ underlying bone quality after fracture or surgery. Her experience includes working as a nurse practitioner in orthopedic trauma, general surgery, trauma, emergency room medicine and as an RN in surgical intensive care. She was a registered respiratory therapist prior to entering nursing.
Patricia obtained her MSN from Columbia University School of Nursing and is currently in the process of obtaining a Master’s in Public Health. She is board certified as an acute care nurse practitioner (ACNP-BC) and holds a certification as an orthopedic nurse practitioner.
Patricia’s fields of academic and clinical interests include ongoing lecturing in areas of metabolic bone and trauma. She has given many lectures at the academic, hospital, and community levels. She recently completed an AORN credentialed RN first assist program. She is a member of the committee in writing for the ONP exam. She joined a team from HSS in a medical mission in providing care to the community of Haiti after the 2010 earthquake.