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.