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Lumbar spine bone mineral density predicts endothelial reactivity in patients with systemic lupus erythematosus
Insights
Systemic lupus erythematosus (SLE) patients show impaired endothelial function linked to lower bone mineral density (BMD). Lumbar BMD predicts endothelial reactivity, suggesting early atherosclerosis in SLE with vertebral bone loss.
Area of Science:
- Rheumatology
- Cardiology
- Endocrinology
Background:
- Systemic lupus erythematosus (SLE) is associated with increased cardiovascular risk.
- Endothelial dysfunction is a key factor in atherosclerosis development.
- The relationship between bone mineral density (BMD) and endothelial function in SLE is not well understood.
Purpose of the Study:
- To investigate the association between endothelial function and BMD in patients with SLE.
- To determine if endothelial function is impaired in SLE patients compared to healthy controls.
- To explore predictors of endothelial function within the SLE cohort.
Main Methods:
- A cross-sectional study comparing 55 SLE patients and 55 matched healthy controls.
- Endothelial function assessed via flow-mediated dilatation (FMD) and carotid intima-media thickness (IMT).
- BMD measured by dual-energy x-ray absorptiometry; hsCRP levels analyzed.
Main Results:
- SLE patients exhibited significantly poorer FMD compared to controls.
- Lower FMD was observed in SLE patients with lumbar osteopenia.
- Multivariate analysis in SLE patients revealed lower FMD correlated with lower lumbar BMD and higher hsCRP.
Conclusions:
- Lumbar BMD is a predictor of endothelial reactivity in SLE patients without overt bone loss or atherosclerosis.
- Vertebral bone loss in SLE may indicate early atherosclerotic disease.
- Endothelial function assessment may be valuable in managing cardiovascular risk in SLE.
Objectives:
To explore whether endothelial function is related to bone mineral density (BMD) in patients with systemic lupus erythematosus (SLE).
Methods:
Consecutive adult SLE patients and age-, sex-, BMI- and smoking-status-matched healthy controls were studied. Subjects with hypertension, hyperlipidemia, diabetes mellitus, renal impairment, dysthyroidism, history of or treatment for cardiovascular and cerebrovascular disorders, antiphospholipid syndrome, positive antiphospholipid antibodies or bone loss were excluded. Endothelial function was assessed by measuring flow-mediated dilatation (FMD) at the brachial artery and carotid intima-media thickness (IMT) by ultrasound. Lumbar and hip BMD were measured by dual-energy x-ray absorptiometry. Fasting blood samples were assayed for atherogenic index and high sensitivity C-reactive protein (hsCRP). Regression models were constructed to study the relationship between FMD and BMD.
Results:
One hundred and ten subjects (55 SLE and 55 matched healthy controls) were studied. While there were no differences between SLE patients and controls in menopausal status, blood pressure, atherogenic index, carotid IMT and BMD, SLE patients had significantly poorer FMD even after adjustment for age, gender, smoking and baseline brachial artery diameter. Also, SLE patients with lumbar osteopenia had significantly lower FMD than those with normal BMD. Multivariate regression revealed that lower FMD was associated with lower lumbar BMD and higher serum hsCRP in SLE patients, but these relationships were absent amongst healthy controls.
Conclusions:
Lumbar vertebral BMD predicted endothelial reactivity in SLE patients without clinically-overt bone loss and atherosclerosis. Thus, early atherosclerotic disease should be considered in lupus patients especially if vertebral bone loss is evident.