Low pre-pregnant body mass index is a risk factor for the decrease of postpartum bone mineral density in systemic lupus erythematosus patients received glucocorticoid therapy

Objectives This study investigated postpartum bone mineral density (BMD) in patients with systemic lupus erythematosus (SLE) receiving long-term glucocorticoid (GC) therapy, assessed risk factors for decreased postpartum BMD, and evaluated change of BMD after postpartum initiation or restarting of osteoporosis drugs. Methods We retrospectively examined 30 SLE patients who gave birth and 31 non-pregnant SLE patients. In the postpartum SLE patients, BMD was measured after delivery and 1 year later. Multivariate analyses were performed to assess risk factors for decreased BMD in postpartum SLE patients. Results Patient age at pregnancy was 34.5 +/- 4.5 years, and SLE duration was 9.7 +/- 6.0 years. The mean prednisolone dose was 9.7 +/- 3.2 mg/day. Body mass index (BMI) was 21.6 +/- 2.2 kg/m(2), with 13 women (43%) experiencing their first delivery. Postpartum BMD was 1.080 +/- 0.120 g/cm(2) in the lumbar spine and 0.834 +/- 0.109 g/cm(2) in the total hip. Bone loss occurred in six patients (21%) in the lumbar spine and 11 patients (37%) in the total hip. Postpartum lumbar spine BMD was significantly reduced compared to that in the non-pregnant group (1.143 +/- 0.120 g/cm(2), p = 0.048). Multivariate analysis identified gestational age and low BMI before pregnancy as risk factors for hip bone loss. Conclusion Postpartum BMD significantly decrease in SLE patients receiving long-term GC, and low BMI before pregnancy was a risk factor for the decrease. Preconception care to prevent osteoporosis and that regularly monitors BMD after delivery are needed.