Bone Health in Juvenile-Onset Systemic Lupus Erythematosus
Osteopenia and osteoporosis occur at a higher frequency in adults with Systemic Lupus Erythematosus (SLE)
compared to healthy controls. Similar findings have been demonstrated in children as well as in adults with juvenile-onset
SLE, though the data are limited. The etiology of poor bone health in these patients is multi-factorial. Causes include direct
effects of the disease itself, with its associated chronic inflammation and low vitamin D levels, as well as indirect effects
such as fatigue resulting in decreased physical activity and poor nutrition. Disease therapy, including medications
such as corticosteroids or non-medical therapy such as sunscreen and sun avoidance, also impacts bone health. Being cognizant
of the long-term effects of SLE itself as well as its treatments on bone health is especially critical in the pediatric
population, as adolescence is the time of peak bone mass accrual. If this window is missed, patients are at an increased
lifetime risk of complications from osteopenia and osteoporosis. In this review article, we will evaluate the published data
regarding bone health in patients who develop SLE in childhood and adolescence as well as risk factors associated with
increased risk of osteopenia and osteoporosis. We will also review the current available imaging techniques and recommendations
for monitoring and maintenance of bone health.
Keywords: Adolescents, bone health, bone mineral density, children, corticosteroids, dual energy X-ray absorptiometry,
osteopenia, systemic lupus erythematosus.
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