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Osteoporosis & Lupus

What is osteoporosis?

Osteoporosis is also known as brittle bone disease. This is because individuals with osteoporosis have bones that break (or fracture) more easily than they should. The most common sites for these fractures to occur are in the wrist, spine and hip. The fractures are painful, but also limit mobility. Not being able to walk around easily lends to a loss of fitness and muscle wasting that can make it difficult for some people to regain independence.

Bones change throughout life

Bones grow and change throughout all our lives. Babies have a skeleton largely made of flexible cartilage, like the cartilage in our noses and ears. Then, as time goes by, we lay down hard bone in the cartilage to form rigid skeleton. The density of this bone is highest in our 20s and 30s, and then starts to reduce slowly. The sex hormone oestrogen, is important in maintaining healthy bones, and as its level decreases after the menopause, bones become more fragile. Despite bones becoming thinner after the menopause, the problems of osteoporosis are rarely seen until people reach their 60s or 70s.

Lupus and osteoporosis

People with lupus are more likely to suffer with osteoporosis than their friends of a similar age. Most people with lupus are women, and women never achieve bones that are as dense or strong as those of men. In addition, as women become menopausal, the bone density falls further. Women with lupus may also have an earlier menopause than average. Lupus is associated with inflammation in the blood, and this seems to make bones thinner as well. Being unwell with lupus may also restrict someone's ability to perform exercise or may reduce muscle strength. Regular exercise is important to maintain strong and healthy bones. Finally, many individuals with lupus require treatment with steroids such as prednisolone, and although these medicines may be vital to treatment they can also cause thinning of the bones, making them even more brittle.

All of these factors also lead to a lower bone density and a greater chance of osteoporosis.

How can we detect osteoporosis?

Usually osteoporosis is detected by measuring how strong or dense someone's bones are, or if they have unexpected fracture in the hip, back or wrist. The measurement of bone density is usually done using a machine called a DEXA scanner. It only takes a few minutes to perform the scan, and it does not hurt. The scanner will give a measure of bone density that would allow a diagnosis of osteoporosis to be made.

Osteoporosis is more likely if a patient smokes, drinks alcohol, has a poor diet, does no exercise or takes steroids. Osteoporosis is also more likely if women have an early menopause.

How can we treat osteoporosis?

The first method of treatment is to alter lifestyle by stopping smoking, drinking within the recommended allowance of alcohol per week, eating a good diet and exercising. The diet must contain some calcium and vitamin D. Calcium is found in dairy products and vitamin D is present in vegetables and oily fish. Vitamin D is also made in the skin when it is exposed to daylight. However, many individuals with lupus have to keep their skin covered to prevent lupus skin rashes or flares of disease. If in doubt it is sensible to consider taking calcium and Vitamin D supplements.

If someone is at high risk of getting osteoporosis or has low bone density, a number of treatments can be used. These include giving calcium and vitamin D tablets. There are also a number of medicines that can increase bone strength that can be taken as tablets or injections. The most common of these medicines are called bisphosphonates. To prevent bones getting too thin while someone is taking steroids, bisphosphonates tablets, calcium and vitamin D are often given at the same time.

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.


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