Hydroxychloroquine therapy and its impact on bone mineral density among systemic lupus erythematosus patients: A cross-sectional study.
5 affiliations
- 1Division of Rheumatology, Department of Internal Medicine, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
- 2Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine - Universitas Airlangga, Surabaya, Indonesia.
- 3Department of Internal Medicine, Faculty of Medicine - Widya Mandala Catholic University, Surabaya, Indonesia.
- 4Department of Radiology, Faculty of Medicine - Universitas Airlangga, Surabaya, Indonesia.
- 5Department of Rheumatology, St Vincent's Hospital, Fitzroy, Australia.
Abstract
Background and objectives
Patients with systemic lupus erythematosus (SLE) are at increased risk of osteoporosis due to chronic inflammation, prolonged glucocorticoid (GC) exposure, and treatment-related factors. Hydroxychloroquine (HCQ), a cornerstone of SLE therapy, has shown conflicting effects on bone health. This study examined the association between HCQ use and bone mineral density (BMD) in SLE.Methods
A cross-sectional study of 213 SLE patients was conducted at Dr. Soetomo General Academic Hospital. BMD was assessed by dual-energy X-ray absorptiometry (DXA) and classified using WHO criteria. Demographic, clinical, laboratory, and treatment-related variables were collected. Group comparisons employed chi-square and non-parametric tests, while ordinal logistic regression identified independent predictors of reduced BMD.Results
Among 213 patients, 22.5% had normal BMD, 51.2% osteopenia, and 26.3% osteoporosis. Independent predictors of reduced BMD were older age (OR 1.05, 95% CI 1.01-1.09), higher cumulative GC exposure (OR 1.07, 95% CI 1.02-1.12), and lower BMI (OR 0.89, 95% CI 0.80-0.98). Importantly, the use of HCQ has been linked to a protective effect against osteoporosis (OR 0.47, 95% CI 0.22-0.97, P = 0.040). Neither SLEDAI scores nor complement/ESR levels were significantly associated with BMD.Conclusion
Low BMD is highly prevalent in SLE and is strongly influenced by age, GC exposure, and BMI. HCQ use was linked to a protective effect on bone health, plausibly mediated by anti-resorptive, antioxidant, and glucocorticoid-sparing properties. Although a causal relationship between these two variables cannot yet be established, this association underscores the need for further well-designed longitudinal or interventional studies.
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BibTeX
@article{awalia2026hydroxychloroquine,
title = {{Hydroxychloroquine therapy and its impact on bone mineral density among systemic lupus erythematosus patients: A cross-sectional study.}},
author = {Awalia and Stefanus Gunawan Kandinata and Arinditia Triasti Putri and Abellia and Lilik Maulidyatus Sholikhah and Rosy Setiawati and Mandana Nikpour},
journal = {Rheumatology and immunology research},
year = {2026},
month = aug,
doi = {10.1515/rir-2026-0017},
url = {https://europepmc.org/article/MED/42923751},
note = {CC BY},
}
RIS
TY - JOUR
TI - Hydroxychloroquine therapy and its impact on bone mineral density among systemic lupus erythematosus patients: A cross-sectional study.
AU - Awalia
AU - Stefanus Gunawan Kandinata
AU - Arinditia Triasti Putri
AU - Abellia
AU - Lilik Maulidyatus Sholikhah
AU - Rosy Setiawati
AU - Mandana Nikpour
PY - 2026
DA - 2026/08/02
JO - Rheumatology and immunology research
DO - 10.1515/rir-2026-0017
UR - https://europepmc.org/article/MED/42923751
AB - Background and objectives Patients with systemic lupus erythematosus (SLE) are at increased risk of osteoporosis due to chronic inflammation, prolonged glucocorticoid (GC) exposure, and treatment-related factors. Hydroxychloroquine (HCQ), a cornerstone of SLE therapy, has shown conflicting effects on bone health. This study examined the association between HCQ use and bone mineral density (BMD) in SLE.Methods A cross-sectional study of 213 SLE patients was conducted at Dr. Soetomo General Academic Hospital. BMD was assessed by dual-energy X-ray absorptiometry (DXA) and classified using WHO criteria. Demographic, clinical, laboratory, and treatment-related variables were collected. Group comparisons employed chi-square and non-parametric tests, while ordinal logistic regression identified independent predictors of reduced BMD.Results Among 213 patients, 22.5% had normal BMD, 51.2% osteopenia, and 26.3% osteoporosis. Independent predictors of reduced BMD were older age (OR 1.05, 95% CI 1.01-1.09), higher cumulative GC exposure (OR 1.07, 95% CI 1.02-1.12), and lower BMI (OR 0.89, 95% CI 0.80-0.98). Importantly, the use of HCQ has been linked to a protective effect against osteoporosis (OR 0.47, 95% CI 0.22-0.97, P = 0.040). Neither SLEDAI scores nor complement/ESR levels were significantly associated with BMD.Conclusion Low BMD is highly prevalent in SLE and is strongly influenced by age, GC exposure, and BMI. HCQ use was linked to a protective effect on bone health, plausibly mediated by anti-resorptive, antioxidant, and glucocorticoid-sparing properties. Although a causal relationship between these two variables cannot yet be established, this association underscores the need for further well-designed longitudinal or interventional studies.
SN - 2719-4523
ER -