Prevalence and Risk Factors of Reduced Bone Mineral Density in Systemic Lupus Erythematosus Patients: A Meta-Analysis

Table 2

Risk factors for reduced bone mineral density in patients with SLE from the literature search.

Study (first author, year)	Country	Study design	Size	Female (%)	Mean age (y)	Outcome	Risk factor	Estimate (aOR, 95% CI)
LAKSHMINARAYANAN et al. 2001	USA	Prospective cohort	92	100	32.8	Low BMD	Menopause	3.32 (1.45, 7.62)
Yee et al. 2004	UK	Case control	242	95.5	39.9	Low BMD	Non-Afro-Caribbean; ever taken prednisolone >10 mg/day	2.5 (1.2, 5.4); 2.1 (1.1, 4.2)
LEE et al. 2007	USA	Case control	298	100	42.1	Low hip BMD	African American race; Age at SLE diagnosis; BMI; Drink caffeine; SDI; SLE renal disease; Current use of GC; Study center	1.54 (0.69, 3.46); 0.98 (0.95, 1.01); 0.90 (0.84, 0.96); 1.33 (0.53, 3.36); 1.30 (1.08, 1.57); 0.79 (0.33, 1.87); 1.48 (0.71, 3.09); 0.95 (0.42, 2.15)
LEE et al. 2007	USA	Case control	298	100	42.1	Low lumbar spine BMD	African American race; Age at SLE diagnosis; BMI/ kg/m2; Drink caffeine; SDI; SLE renal disease; Current use of GC; Study center	4.42 (2.19, 8.91); 0.96 (0.93, 0.99); 0.93 (0.89, 0.98); 0.34 (0.17, 0.72); 1.06 (0.89, 1.26); 1.50 (0.71, 3.16); 1.54 (0.81, 2.92); 0.71 (0.33, 1.53)
Furukawa et al. 2011	Japan	Case control	58	100	44.0	Low BMD	Number of deliveries; Maximal dosage of >50 mg/day of oral GC	5.58 (1.31, 26.06); 0.25 (0.07, 0.91)
Lim et al. 2011	Canada	Retrospective cohort	80	82.5	14.2a	Low BMD	Higher BMI z score	0.35 (0.18, 0.69)
Bonfá et al. 2015	Brazil	Case control	365	100	32.8	Low BMD	Current GC use; Osteoprotegerin 245 T>G	3.97 (1.51, 10.41); 2.14 (1.02, 4.50)
Seguro et al. 2015	Brazil	Prospective cohort	63	100	31.1	Low BMD	NPT1; Cumulative GC; Mean GC; Maximum GC	1.03 (1.01–1.05); 1.00 (1.00–1.00); 1.0 (0.95, 1.04); 0.98 (0.95, 1.01)
Cramarossa et al. 2016	Canada	Prospective cohort	286	88.8	38.0	Low BMD	Age; Female; Cumulative ACR criteria; SDI excluding Osteoporosis; Vitamin D use; Calcium use; Bisphosphonates use; Immunosuppressives use; Cumulative GC dose	1.06 (1.04, 1.08); 0.47 (0.23, 1.00); 0.80 (0.63, 1.02); 1.43 (1.12, 1.82) 1.63 (0.94, 2.80) 1.63 (0.94, 2.80) 1.72 (0.85, 3.47) 1.51 (0.90, 2.52); 1.04 (1.01, 1.07)
Lacassagne et al. 2007	Canada	Prospective cohort	64	76.6	14.3	Osteopenia	Cumulative GC dose	1.003 (1.001, 1.01)
Mak et al. 2011	Singapor	Case control	110	87	40.5	Osteopenia	Disease duration/month; BMI/kg/m2; Cyclosporine use; Cumulative GC dose; FMD/%; Carotid IMT/mm	1.031 (0.99, 1.073; 0.78 (0.53, 1.16); 0.014 (0.00, 1.01); 1.080 (0.85, 1.38); 0.147 (0.02, 0.96); 0.000 (0.000)
SINIGAGLIA et al. 1999	Italy	Case control	84	100	30.5	Osteoporosis	Disease duration/year; Prednisone/year-use	1.2 (1.07, 1.33); 1.16 (1.05, 1.29)
Banno et al. 2002	Japan	Case control	60	100	34.8	Osteoporosis	Cumulative GC intake	1.06 (1.01, 1.11)
Yee et al. 2004	UK	Case control	242	95.5	39.9	Osteoporosis	Menopause; Age/year	13.3 (1.6, 111.1); 1.0 (1.0, 1.1)
Lacassagne et al. 2007	Canada	Prospective cohort	64	76.6	14.3	Osteoporosis	Disease duration/year; lupus nephritis	1.60 (1.18, 2.18); 8.79 (0.96, 80.24)
Crosslin et al. 2011	USA	Case control	14829	90.5	47.3	Osteoporosis	Male	0.65 (0.43, 0.97)
Ajeganova et al. 2015	Sweden	Case control	222	89	48.7	Osteoporosis	Carotid plaque	1.78 (0.97, 3.24)

Note: OR, odds ratio; USA, United States of America; BMD, bone mineral density; UK, the United Kingdom of Great Britain and Northern Ireland; BMI, Body mass index; SLICC/ACR-DI, the Systemic Lupus International Collaborating Clinics/American College of Rheumatology-Damage Index; GC, glucocorticoid; NPT1, N-terminal propeptide of type 1 collagen; FMD, flow-mediated dilatation. Hint: ; aRR: adjusted risk ratio.