Skeletal Manifestations of Systemic Autoimmune Diseases
SOURCE: Current Opinion in Endocrinology 2010 (Dec); 17 (6): 540–545
[Editor’s Note: Although this article tilts towards medical management, this review of physical findings in various autoimmune diseases will be a useful refresher course for the field. Don’t forget to tally this as part of your Continuing Ed hours.]
Several autoimmune diseases carry with them an increased risk of osteoporotic fractures and osteonecrosis, adding significantly to the morbidity and mortality of these conditions. The accelerated bone mineral density (BMD) and integrity loss seen with these diseases is often not entirely explained by traditional risk factors, and autoimmunity itself may play a role in its pathogenesis. Mechanisms for skeletal change not only include some well defined risk factors, such as corticosteroid use, but may also include chronic inflammation and immune dysregulation. The complex nature of these processes carries implications for the prevention and treatment of osteoporosis and osteonecrosis among patients with autoimmune diseases.
In this review, we will focus on the most recent studies of inflammatory effects on bone and skeletal manifestations of systemic autoimmune diseases, particularly rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). We include a discussion of vitamin D and its effects on autoimmunity, bone health and fracture outcomes. We will also include practice recommendations for providers with the goal of predicting overall fracture risk and lowering that risk in patients with autoimmune disease.