Prevalence and determinants of vertebral fractures in a SLE cohort

Objectives Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterised by multiorgan involvement. Osteoporosis and fragility fractures, particularly vertebral fractures, are significant, yet often underestimated, comorbidities in patients with SLE. This study aims to evaluate the prevalence of vertebral fractures and their associations with demographic, disease-related and therapy-related factors in patients with SLE. Methods We conducted a monocentric, cross-sectional study to systematically evaluate bone health using dual-energy X-ray absorptiometry and vertebral fracture assessment (VFA). Associations between vertebral fractures and clinical, laboratory variables were investigated with logistic and linear regressions. Results One hundred and six patients with SLE were included. The overall prevalence of radiographic vertebral fractures was 21.7%, whereas clinical vertebral fractures were reported in 14.2% of patients. New, previously not diagnosed, radiographic vertebral fractures were detected in 14.2% of all patients with SLE at screening with VFA. Older age, longer disease duration, cumulative glucocorticoid (GC) dose and lower bone mineral density were significantly associated with vertebral fractures. Cumulative GC dose had the strongest association with vertebral fractures. We also found a positive association between the number of vertebral fractures on VFA and cumulative GC dose (beta 0.025, p=0.025). Conclusions Our findings underscore the importance of actively screening for vertebral fractures in patients with SLE, especially those on long-term GC therapy, to prevent underdiagnosis, mitigate the risk of further skeletal damage and facilitate the timely initiation of targeted antiosteoporotic treatments when indicated.