SYSTEMATIC REVIEW AND META-ANALYSIS: THE EFFECT OF SYSTEMIC LUPUS ERYTHEMATOSUS AND LONG-TERM STEROID THERAPY ON BONE MASS IN POSTMENOPAUSAL WOMEN

Abstract

Background: This systematic review and meta-analysis objective was to assess the effect of systemic lupus erythematosus (SLE) and long-term glucocorticoid therapy on bone mineral density (BMD) in premenopausal women.The risk of osteoporosis due to disease and steroid treatment.
Methods: This systematic review and meta-analysis followed the PRISMA guidelines to assess the impact of long-term glucocorticoid therapy on bone mineral density (BMD) in premenopausal women with systemic lupus erythematosus (SLE). A broad search was
conducted in PubMed, Scopus, Web of Science, and the Cochrane Library for studies published from January 2020 to December 2024. Studies focused on premenopausal women with SLE evaluating BMD changes due to glucocorticoid therapy. Two reviewers independently extracted data regarding sample size, age, treatment duration, and key findings. The quality of studies was assessed using the Newcastle-Ottawa Scale. A random-effects meta-analysis was performed to calculate standardized mean differences (SMD) and 95% confidence intervals (CIs), with heterogeneity assessed via the I² statistic. Sensitivity analyses were conducted to ensure the robustness of the findings.
Results: A total of 22 studies, studies design, was mostly observational and cross-sectional. Most studies noted a significant decrease in bone mineral density linked to long-term steroid use. Mendoza et al. (2021) highlighted this reduction, followed by Boone et al. (2021) who established a strong association between steroid therapy duration and low BMD. These studies indicated that long-term steroid therapy correlates with increased fracture risk, as highlighted by Ciobîcă et al. (2021) and Tsai et al. (2022). There was significant correlation between cumulative steroid doses and BMD reduction, consistent by findings from Danza et al. (2020) and Shevchuk et al. (2021). Some studies Watts et al. (2021), found no significant effects of steroid therapy on BMD, indicating inconsistency that could be attributed to differences in study populations/methodologies. Several studies highlighted the negative effects of systemic inflammation and disease activity on bone metabolism, reinforcing the multifaceted nature of bone health in SLE patients.
Conclusions: This review indicate a strong association between long-term steroid use and reduced BMD in premenopausal women with SLE. The evidence underline that cumulative exposure to glucocorticoids significantly impacts bone health, leading to ahigher risk of fractures and osteoporosis. Inconsistency in the outcomes across different studies proposes the need for careful consideration of factors: age, steroid duration, and disease activity when assessing bone health our population. Clinicians should implement monitoring and preventive strategies to lessen the risk of osteoporosis and fractures in women undergoing glucocorticoid therapy for SLE.