What Lupus Patients need to know about Osteoporosis

What is Osteoporosis?
Osteoporosis is a condition in which the bones become less dense and more likely to fracture. Fractures from osteoporosis can result in significant pain and disability. It is a major health threat for an estimated 44 million Americans, 68% of whom are women.
Risk factors for developing osteoporosis include: thinness or small frame; family history of the disease; being postmenopausal or having had early menopause; abnormal absence of menstrual periods; prolonged use of certain medications, such as glucocorticoids; low calcium intake; physical inactivity; smoking; and excessive alcohol intake. 
Osteoporosis is a silent disease that can often be prevented. However, if undetected, it can progress for many years without symptoms until a fracture occurs.
The Lupus-Osteoporosis Link
Studies have found an increase in bone loss and fracture in individuals with SLE. In fact, women with lupus may be five times more likely to experience a fracture from osteoporosis. 
Individuals with lupus are at increased risk for osteoporosis for many reasons. To begin with, the glucocorticoid medications often prescribed for the treatment of SLE can trigger significant bone loss. In addition, pain and fatigue caused by the disease can result in inactivity, further increasing osteoporosis risk. Studies also sh ow that bone loss in lupus may occur as a direct result of the disease. Of concern is the fact that 90 percent of the individuals affected with lupus are women, a group already at increased osteoporosis risk. 
Osteoporosis Management Strategies
Strategies for the prevention and treatment of osteoporosis in people with lupus are not significantly different from the strategies for those who do not have the disease. 
Nutrition and Exercise. A diet rich in calcium and vitamin D is important for healthy bones. Good sources of calcium include low fat dairy products, dark green, leafy vegetables, and calcium fortified foods and beverages. Also, supplements can help ensure that the calcium requirement is met each day. 
Vitamin D plays an important role in calcium absorption and bone health. It is synthesized in the skin through exposure to sunlight. While many people are able to obtain enough vitamin D naturally, excessive sun exposure can trigger flares in some people with lupus. These individuals may require vitamin D supplements in order to ensure an adequate daily intake. 
Like muscle, bone is living tissue that responds to exercise by becoming stronger. The best exercise for your bones is weight-bearing exercise that forces you to work against gravity. Some examples include walking, stair-climbing and dancing. 
Exercising can be challenging for people with lupus who are affected by joint pain and inflammation, muscle pain and fatigue. However, regular exercises such as walking can help prevent bone loss and provide many other health benefits. 
Healthy Lifestyle. Smoking is bad for bones, as well as the heart and lungs. Women who smoke tend to go through menopause earlier, triggering earlier bone loss. In addition, smokers may absorb less calcium from their diets. Alcohol can also negatively affect bone health. Those who drink heavily are more prone to bone loss and fracture, both because of poor nutrition as well as increased risk of falling. 
Bone Density Test. Specialized tests known as bone mineral density (BMD) tests measure bone density in various sites of the body. These tests can detect osteoporosis before a fracture occurs and predict one’s chances of fracturing in the future. Lupus patients, particularly those receiving glucocorticoid therapy for two months or more, should talk to their doctors about whether they might be a candidate for a bone density test.
Medication. Like lupus, there is no cure for osteoporosis. However, there are medications available for the prevention and treatment of osteoporosis. Several medications (estrogen / hormone replacement therapy, alendronate, risedronate, raloxifene and calcitonin) are approved by the Food and Drug Administration (FDA) for the prevention and/or treatment of osteoporosis in postmenopausal women. Alendronate is also approved for use in men. For lupus patients on glucocorticocoid therapy, alendronate (for treatment) and risedronate (for prevention and treatment) are approved for glucocorticoid-induced osteoporosis.