Women more often than men are faced with the challenge of autoimmune diseases like lupus.  Another condition that is found more commonly in women than men is osteoporosis.  Simply speaking osteoporosis means bones that break relatively easy.

There are many reasons to consider osteoporosis in patients who have lupus.  First of all, the most common treatments for lupus often include corticosteroids such as prednisone.  While this can be a life-saving drug for people with lupus, it carries with it the possibility of various side effects, not the least of which is osteoporosis.

In addition, women with lupus may have an early menopause.  It is during the time of menopause that women lose the hormonal support for their bone tissue and the bone begins to dissolve.  Sometimes this occurs relatively rapidly within the first five to seven years of menopause.  This is a prime time for looking for osteoporosis and establishing plans to prevent it or treat it.

Fortunately within the last ten years there have been great strides forward in the diagnosis and treatment of osteoporosis.  Although many of the exact details of the process are not completely understood we do know a few of the fundamentals.  

First of all, it is necessary to receive adequate amounts of Vitamin D and calcium each day to support your bones.  The NIH has recommended that women receive between 1,000 and 1,500 mg of calcium each day over the course of a day. Typically a glass of milk contains about 300 mg of calcium.  There are other sources of calcium including over-the-counter supplements. Usually the label is quite clear about the calcium content so that you can add up your daily needs. In addition, it is necessary to get between 400 units and 800 units of Vitamin D each day for good bone health. A typical Multi-Vitamin has 400 units of Vitamin D although many of the calcium supplements also contain Vitamin D. Like most things it is possible to get too much of a supplement such as calcium or Vitamin D and thus it is important to clarify your needs with your doctor. In addition, it is appropriate to have some blood tests and possibly urine tests done to evaluate you for other bone related problems that may require a different treatment.

Calcium and Vitamin D alone are not adequate to prevent fractures in a patient with osteoporosis who is menopausal and on steroids.  There are numerous prescription medications available to treat osteoporosis in this setting.  The most successful medication class is a group of drugs known as bisphosphonates.   There is ample amount of data available in the medical literature that shows these medications can not only increase your bone density but also reduce the chance of you having a fracture in the future, particularly a hip fracture or a collapse of your vertebrae in your spine.

There are other categories of medications that have been used including hormone replacement and calcitonin.  The scientific data showing that these medications reduce the risk of fracture is not as strong as that for bisphosphonates, such as alendronate or risedronate.

The best way to establish whether or not you have osteoporosis is to undergo a relatively simple test called “bone densitometry.”  This test is typically performed in the doctor’s office or radiology suite and usually takes only 15 to 20 minutes to run.  It does not involve injections or needles and the radiation dose is less than that of a chest x-ray.  The bone densitometry test that is most often relied on is known as a “DEXA scan.”  Your doctor can sit down with you and interpret these results with you and help decide whether or not you have cause for concern.  If need be there are certainly specialists in this area such as endocrinologists and rheumatologists who can advise you further.

We continue to make strides forward in the treatment of lupus and it is important to recognize that there are related conditions such as osteoporosis that must also be considered and treated when necessary.  Fortunately we do have powerful diagnostic and therapeutic choices now that allow you to understand better about the condition of osteoporosis.