AB0529 An audit for screening of osteoporosis and its management in patients with systemic lupus erythematosus
Authors: S.A. Syed, K. Sunmboye, S. Shaffu
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Systemic lupus erythematosus (SLE) is an autoimmune, multi-system, chronic inflammatory condition. It is managed with long-term immunosuppressive therapy which includes steroid use. SLE is therefore considered an independent risk factor for osteoporosis. <h3>Objectives</h3> This clinical audit was undertaken to evaluate the screening of osteoporosis in patients diagnosed with SLE and assess adherence to national guidelines for the management of patients with low bone mineral density (BMD) on prolonged steroid therapy. <h3>Methods</h3> We studied 64 SLE patients seen at the Leicester Royal Infirmary. Demographic and clinical data was collected from the clinic letters. Steroid use for a cumulative period of over 4 weeks per year was considered significant and use of bisphosphonates or calcium and vitamin D supplements alone were taken into account for bone protection. BMD measurements by dual X-ray absorptiometry were performed. Osteoporosis was defined as a T score less than −2.5 SD in at least 1 region of measurement. <h3>Results</h3> Of the 64 patients studied, 54 (84.4%) were female and 10 (15.6%) male with an age range of 23 to 86 years and mean age of 47.45 years. Steroids were used in 46 (71.9%) patients while 18 (28.1%) patients did not receive any steroids. Twenty-one (32.8%) patients had DEXA scans and whilst 43 (67.2%) had not. Of those who had received steroids, 20 (43.4%) patients underwent DEXA scans and 26 (56.5%) did not. Osteoporosis was diagnosed in 3 (14.3%) patients out of the 21 scanned. The therapies used are summarised in figure 1. <h3>Conclusions</h3> Studies have shown that SLE is an independent risk factor for low BMD and use of corticosteroids is already a well-recognised risk for osteoporosis. Our study has shown that a large section of patients (43.8%) did not receive any form of bone protection although, a significant proportion (71.9%) were on oral steroids. Although a small section of those scanned demonstrated osteoporosis (14.3%), many patients were already initiated on bisphosphonates without a DEXA. There was also no exclusion criteria set for young patients (age &lt;45 years) or those who were newly diagnosed. Despite this, our study demonstrates the need for robust guidelines for the screening and management of bone health in patients with SLE in order to improve morbidity and mortality rates in this patient cohort. <h3>References</h3> [1] Mosca M,1 C Tani,1 M Aringer, et al. European League Against Rheumatism recommendations for monitoring patients with systemic lupus erythematosus in clinical practice and in observational studies. [2] Almehed K, Forsblad d'Elia H, Kvist G, et al. Prevalence and risk factors of osteoporosis in female SLE patients-extended report. Rheumatology (Oxford)2007;46:1185–1190. [3] Bultink IE, Lems WF, Kostense PJ, et al. Prevalence of and risk factors for low bone mineral density and vertebral fractures in patients with systemic lupus erythematosus. Arthritis Rheum2005;52:2044–2050. [4] NOGG 2017: Clinical guideline for the prevention and treatment of osteoporosis. <h3>Acknowledgements</h3> We acknowledge the contribution of the clinical audit team at the University hospitals of Leicester NHS trust for their help in analysing the data. <h3>Disclosure of Interest</h3> None declared