The Lupus-Osteoporosis Link
From the National Institutes of Health's Osteoporosis and Related Bone Diseases ~ National Resource Center

Studies have found an increase in bone loss and fracture in individuals with SLE. In fact, women with lupus may be nearly 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 to treat 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 show 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
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.

Exercise
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, climbing stairs, weight lifting, 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 and an increased risk of falling.
Bone density test: Specialized tests known as bone mineral density (BMD) tests measure bone
density at 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 2 months or more, should talk to their doctors about whether they might be candidates fora bone density test.

Medication
Like lupus, osteoporosis is a disease with no cure. However, there are medications available to
prevent and treat osteoporosis. Several medications (alendronate, risedronate, ibandronate,
raloxifene, calcitonin, teriparatide, and estrogen/hormone therapy) 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 people with lupus who develop or may develop glucocorticoid-induced osteoporosis, alendronate has been approved to treat this condition and risedronate has been approved to treat and prevent it.