Features of Bone Mineral Density, Calcium-Phosphorus Metabolism and Bone Remodeling in Patients with Systemic Lupus Erythematosus

Abstract

Introduction. Systemic lupus erythematosus (SLE) is a complex autoimmune disease with variable clinical manifestations associated with multiple autoantibodies formation and deposition of immune complexes, and other immune processes. Despite significant advances in treatment, the disease remains disabling, in particular, due to increased bone fragility and low-energy fractures. The study of bone remodeling in patients with SLE should help to improve the therapy and quality of their treatment. The aim of the study. To investigate the features of bone mineral density, calcium-phosphorus metabolism and bone remodeling in patients with systemic lupus erythematosus. Materials and methods. The study involved 123 women with SLE aged 21-51 years. The comparison group (CG) consisted of 25 women without SLE in premenopausal status of the appropriate age. The control group included 25 practically healthy women. In order to study bone mineral density (BMD), dual-energy X-ray densitometry (DXA) of the lumbar spine was performed using a dual-energy X-ray absorptiometer. For the study of calcium-phosphorus metabolism (CPM), total  calcium (Ca), ionized Ca, phosphorus (P) in blood and Ca, P, creatinine in daily urine, as well as parathyroid hormone (PTH) and 25-hydroxyvitamin D in serum were determined. Markers of bone remodeling (osteocalcin, procollagen type 1 amino-terminal propeptide (P1NP) and isomerized C-terminal telopeptide (β-crosslaps) in serum were measured. To achieve the stated goal, the first step included the determination of bone damage prevalence in patients with the diagnosed SLE; the second step was directed towards the characterization the particular bone condition in patients with SLE based on the  results of BMD, CPM indices and markers of bone remodeling assessment. Results and discussion. According to the results of DXA of the lumbar spine, 88 (71.54 %) women of the SG and only 8 (32.00 %) women of the CG had a decrease in BMD (p < 0.001). According to the mean values, the studied CPM indices of the SG patients, CG and control group wemen exposed no significant differences. Similarly, no significant differences were detected in the mean values of urinary phosphorus and in between blood PTH values in SG, CG, and control. The level of 25-hydroxyvitamin D was significantly lower in SG (15.14 ± 0.80 ng/ml) than in CG (19.62 ± 0.46 ng/ml) and control (22.38 ± 1.34 ng/ml) p < 0.05. The mean value of osteocalcin in woman with SLE was significantly lower than in CG and control (11.81 ± 0.49 ng/ml versus 18.61 ± 0.75 ng/ml and 19.28 ± 1.88, p < 0.001). No significant difference were detected in between the mean values of P1NP in SG, CG and control. The mean values of β-cross laps were significantly higher in patients with SLE (0.51 ± 0.02 ng/ml) compared to GC (0.26 ± 0.02 ng/ml) and control (0.28 ± 0.02 ng/ml), p < 0.001. Conclusions. Bone mineral density, calcium-phosphorus metabolism and bone remodeling in patients with systemic lupus erythematosus have peculiarities as follows: a significant decrease in bone mass in 71.54 % of patients, namely 18, 70 % - grade I osteopenia, 21.14 % - grade II osteopenia, 14.63 % - grade III osteopenia; 17.07 % - osteoporosis, increased calcium excretion, vitamin D deficiency, decreased osteoblastic and enhansed osteoclastic functions.