Bone Mineral Density and Serum Vitamin D 25-hydroxyvitamin D Levels in Childhood- or Juvenile-onset Systemic Lupus Erythematosus: A Systematic Review and Meta-analysis

Context: Patients with systemic lupus erythematosus (SLE), particularly those with childhood or juvenile onset, face a higher risk of complications due to low bone mineral density (BMD) and reduced serum Vitamin D levels. Aims: The aim of this study was to report BMD Z -score and serum Vitamin D 25-hydroxyvitamin D (25-(OH)D) levels in a population with childhood- or juvenile-onset SLE and to analyze associations between BMD Z -score, serum Vitamin D, SLE Disease Activity Index (SLEDAI) score, and disease duration. Settings and Design: This study is a systematic review and meta-analysis. Methods: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched PubMed and Scopus for all relevant studies published up to March 1, 2024, using the keywords (“Systemic Lupus Erythematosus” OR “SLE”) AND (“Childhood” OR “Pediatric” OR “Juvenile”) AND (“Bone Mineral Density” OR “Vitamin D”). A random-effects model with Knapp–Hartung adjustments estimated confidence intervals (CIs), and a restricted maximum likelihood estimator assessed heterogeneity. Meta-regression analyzed associations between BMD Z -score, serum Vitamin D, SLEDAI score, and disease duration. Results: Our study found a pooled BMD Z -score of −1.10 (95% CI: −1.43, −0.77) across 14 studies (831 subjects) and serum Vitamin D levels of 19.75 ng/mL (95% CI: 17.83, 21.66) across 20 studies (1555 subjects). Meta-regression showed no significant association between BMD Z -score or serum Vitamin D with SLEDAI score, disease duration, or each other. Conclusions: Childhood- or juvenile-onset SLE is associated with lower BMD Z -score and Vitamin D deficiency. There is no association between BMD Z -score or serum Vitamin D levels and SLEDAI score or years since diagnosis.