Role of Prednisone and 25‐Hydroxyvitamin D on Bone Mineral Density and Osteoporosis in Systemic Lupus Erythematosus
Authors' conclusion
Prednisone dose, even at 5 mg/day, and low mean 25(OH)D levels were found to be modifiable predictors of osteoporosis. Mean (reflecting supplementation), rather than initial, 25(OH)D levels were significantly associated with BMD. Some of the bone loss from prior prednisone use appears to be reversible.
Study context
- Population
- Lupus cohort of patients with systemic lupus erythematosus (SLE)
- Participants
- 1,003 participants
- Outcome
- Osteoporosis (T score ≤ −2.5) and BMD (spine T scores)
Methodological detailsgeneralized estimating equations, univariate and multivariate analysis
- Generalized estimating equations
- Univariate and multivariate analysis
Main finding
As reported in the abstract
Predictors of osteoporosis (multivariate analysis)
- Older age remained a predictor of osteoporosis
- Lower body mass index (BMI) remained a predictor of osteoporosis
- Low mean 25(OH)D levels remained a predictor of osteoporosis
- Prednisone dose >5 mg/day remained a predictor of osteoporosis
Observational data: associations, not effects.
Further findings
Osteoporosis (univariate analysis)
- Older age, lower BMI, mean past SLE activity (SELENA-SLEDAI > 2), mean daily prednisone dose at any level, and history of low C3 or C4 associated with osteoporosis
Lower spine T scores (univariate analysis)
- Older age, lower BMI, mean 25(OH)D levels, mean daily prednisone dose (any dose), and prior low C3 associated with lower spine T scores
Spine T scores after prednisone discontinuation
- Discontinuation of prednisone within one year before the next bone mineral density (BMD) measurement led to higher mean spine T scores
Original publication
Role of Prednisone and 25‐Hydroxyvitamin D on Bone Mineral Density and Osteoporosis in Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken). Published 30 January 2026. doi:10.
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