Bone mineral density in women with systemic lupus erythematosus, its association with bone turnover markers, levels of estradiol and interleukin-6
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Department of Internal Medicine No 2, National Pirogov Memorial Medical University, Vinnytsia, Ukraine
Department of Rheumatology, Scientific and Research Institute of Invalid Rehabilitation (educational scientific treatment complex) of National Pirogov Memorial Medical University, Vinnytsia, Ukraine
Submission date: 2020-04-08
Final revision date: 2020-05-07
Acceptance date: 2020-05-08
Online publication date: 2020-09-07
Corresponding author
Liudmyla Denyshchych   

National Pirogov Memorial Medical University, Khmelnytske shose 104, Vinnytsia, Ukraine. Tel.: +380971495380.
Pol. Ann. Med. 2020;27(2):128-134
Osteoporosis is frequently diagnosed in patients with systemic lupus erythematosus (SLE). Potential causes and mechanisms of the development of this disease in patients with SLE are still being studied.

To study bone mineral density (BMD) of women with SLE in Ukraine, evaluate its association with the level of bone turnover markers, interleukin-6 (IL-6) and serum estradiol levels.

Material and methods:
In total, 91 SLE women and 29 healthy individuals were examined. Apart from clinical risk factors for osteoporosis development, the levels of IL-6, bone formation and resorption markers, serum estradiol and their association with reduced BMD were evaluated. The deterioration of BMD was detected by dual-energy X-ray absorptiometry.

Results and discussion:
Reduced BMD in women with SLE is found in 35.2%. In the study group, 28 women with SLE (48.3%) have decreased levels of bone formation markers, while 30 women (51.7%) have increased bone resorption markers. Imbalance of bone metabolism is highly associated with the severity of the disease, IL-6, and an exposure dose of glucocorticoids. The level of estradiol in women with SLE is 1.8 times lower than in individuals from the control group. The deterioration of the BMD is closely related to the bone turnover disorder, level of IL-6 and estradiol.

Independent predictors of BMD disorder in SLE women are levels of osteocalcin and C-terminal telopeptide of type I collagen as well as IL-6 and decreased level of serum estradiol.

This research was supported by government funding. It is a part of the research work performed by the department of internal medicine № 2 of National Pirogov Memorial Medical University: ‘To study clinical, metabolic, genetic and immunoinflammatory factors of development of osteoporosis and sarcopenia in patients with systemic lupus erythematosus,’ state registration number 0119U101281.
None declared.
Bultink IEM. Bone disease in connective tissue disease/systemic lupus erythematosus. Calcif Tissue Int. 2018;102(5):575–591.
Amarasekara DS, Yun H, Kim S, Lee N, Kim H, Rho J. Regulation of osteoclast differentiation by cytokine networks. Immune Netw. 2018;18(1):e8.
Zhao R. Immune regulation of osteoclast function in postmenopausal osteoporosis: A critical interdisciplinary perspective. Int J Med Sci. 2012;9(9):825–832.
Krum SA. Direct transcriptional targets of sex steroid hormones in bone. J Cell Biochem. 2011;112(2):401–408.
Aringer M, Costenbader K, Daikh D, et al. 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus. Ann Rheum Dis. 2019;78(9):1151–1159.
Gladman D, Ginzler E, Goldsmith C, et al. The development and initial validation of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index for systemic lupus erythematosus. Arthritis Rheum. 1996;39(3):363–369.
Gu C, Zhao R, Zhang X, et al. A meta-analysis of secondary osteoporosis in systemic lupus erythematosus: prevalence and risk factors. Arch Osteoporos. 2019;15(1):1.
Cramarossa G, Urowitz MB, Su J, Gladman D, Touma Z. Prevalence and associated factors of low bone mass in adults with systemic lupus erythematosus. Lupus. 2017;26(4):365–372.
Povoroznyuk VV, Dzerovich NI, Karasevskaya TA. Bone mineral density in ukrainian women of different age. Ann N Y Acad Sci. 2007;1119:243–252.
Guo Q, Fan P, Luo J, et al. Assessment of bone mineral density and bone metabolism in young male adults recently diagnosed with systemic lupus erythematosus in China. Lupus. 2017;26(3):289–293.
Teichmann J, Lange U, Stracke H, et al. Bone metabolism and bone mineral density of systemic lupus erythematosus at the time of diagnosis. Rheumatol Int. 1999;18(4):137–140.
Handono K, Arthamin MZ, Sari TL, Adam AA, Anggraeny O. Homocysteine, folic acid, vitamin B6, vitamin B12, and biochemical parameters of bone metabolism in female patients with systemic lupus erythematosus. J Clin Cell Immunol. 2014;5:3.
Chapurlat RD, Garnero P, Sornay-Rendu E, Arlot ME, Claustrat B, Delmas PD. Longitudinal study of bone loss in pre- and perimenopausal women: Evidence for bone loss in perimenopausal women. Osteoporos Int. 2000;11(6):493–498.
Garnero P, Sornay-Rendu E, Duboeuf F, Delmas PD. Markers of bone turnover predict postmenopausal forearm bone loss over 4 years: The OFELY study. J Bone Miner Res. 1999;14(9):1614–1621.
Iki M, Morita A, Ikeda Y, et al. Biochemical markers of bone turnover predict bone loss in perimenopausal women but not in postmenopausal women-the Japanese Population-based Osteoporosis (JPOS) Cohort Study. Osteoporos Int. 2006;17(7):1086–1095.
Seguro LP, Casella CB, Caparbo VF, et al. Lower P1NP serum levels: a predictive marker of bone loss after 1 year follow-up in premenopausal systemic lupus erythematosus patients. Osteoporos Int. 2015;26(2):459–467.
Yao HH, Tang SM, Wang ZM, et al. Study of bone mineral density and serum bone turnover markers in newly diagnosed systemic lupus erythematosus patients. Beijing Da Xue Xue Bao Yi Xue Ban. 2018;50(6):998–1003.
Sarkissian A, Sivaraman V, Bout-Tabaku S, et al. Bone turnover markers in relation to vitamin D status and disease activity in adults with systemic lupus erythematosus. Lupus. 2019;28(2):156–162.
Hansen M, Halberg P, Kollerup G, et al. Bone metabolism in patients with systemic lupus erythematosus. Effect of disease activity and glucocorticoid treatment. Scand J Rheumatol. 1998;27(3):197-206. 10.1080/030097498440813.
Dovio A, Perazzolo L, Osella G, et al. Immediate fall of bone formation and transient increase of bone resorption in the course of high-dose, short-term glucocorticoid therapy in young patients with multiple sclerosis. J Clin Endocrinol Metab. 2004;89(10):4923–4928.
Kokic V, Martinovic Kaliterna D, Radic M, Perkovic D, Cvek M, Capkun V. Relationship between vitamin D, IFN-γ, and E2 levels in systemic lupus erythematosus. Lupus. 2016;25(3):282–288.
McMurray RW, May W. Sex hormones and systemic lupus erythematosus: Review and meta-analysis. Arthritis Rheum. 2003;48(8):2100–2110.
Verthelyi D, Petri M, Ylamus M, Klinman DM. Disassociation of sex hormone levels and cytokine production in SLE patients. Lupus. 2001;10(5):352–358.
Muñoz JA, Gil A, López-Dupla JM, Vázquez JJ, González-Gancedo P. Sex hormones in chronic systemic lupus erythematosus. Correlation with clinical and biological parameters. Ann Med Interne (Paris). 1994;145(7):459–463.
Shabanova, SS, Ananieva LP, Alekberova ZS, Guzov II. Ovarian function and disease activity in patients with systemic lupus erythematosus. Clin Exp Rheumatol. 2008;26(3):436–441.
Lahita RG. Sex steroids and SLE: Metabolism of androgens to estrogens. Lupus. 1992;1(3):125–127.
Ward MM. Prevalence of physician-diagnosed systemic lupus erythematosus in the United States: Results from the third national health and nutrition examination survey. J Womens Health (Larchmt). 2004;13(6):713–718.
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