Increased Risk of Osteonecrosis in Lupus May be Caused by Prednisone


Researchers at Johns Hopkins School of Medicine noted that osteonecrosis (ON) is one of the more serious complications of systemic lupus erythematosus (SLE). According to a recent article in Healio, daily doses of 20 to 39 mg or higher of prednisone if taken daily for over one month caused a significant increase in the risk of ON.

In fact, prednisone taken for one month at 40 mg is perhaps the most critical predictor of ON in SLE.

About Osteonecrosis (ON)

ON involves the loss of blood flow to bone tissue, causing bone death. Bones in the knees, hips, ankles, and shoulders are generally affected. Long-term use of steroid medicines, joint injuries, alcohol abuse, and diseases such as arthritis or cancer may cause ON. Also, the disease may surface at any time after cancer therapy involving bisphosphonates, methotrexate, or corticosteroids. Corticosteroids are steroid hormones created by the cortex (exterior) of the adrenal gland.

The aforementioned risk factors were determined by studying the increased incidence of ON in patients with SLE and comparing them to the general public. Glucocorticoid use continues to be the most critical risk factor. It has yet to be determined if the risk of ON is increased by the length of corticosteroid treatment, high daily dosing, or cumulative dosage.

An Analysis From Johns Hopkins

The researchers studied data from 1987 and later years to analyze predictors of ON. The focus was primarily on prednisone, its dosage, and duration of treatment.

The data contains records from Johns Hopkins containing the SLE patients’ medical history as well as laboratory and clinical information. The researchers studied data of 2,428 SLE patients. They looked for a correlation between rates of ON and risk factors. They identified variables related to the incidence of ON and determined the most critical risk factors:

  • African Americans were two times more at risk than whites
  • Men were eighty percent more at risk for ON than women
  • Smokers were fifty percent more at risk than non-smokers
  • As people aged, every ten years their risk of ON decreased by twenty percent

It is noteworthy that patients who were diagnosed post-1990s had a fifty percent reduction in risk for ON when compared to people diagnosed in prior years.

The good news is that according to the voclosporin trial and the Rituxilup pilot study, oral steroids can now be used more safely and conservatively even for lupus patients.

Rose Duesterwald

Rose Duesterwald

Rose became acquainted with Patient Worthy after her husband was diagnosed with Acute Myeloid Leukemia (AML) six years ago. During this period of partial remission, Rose researched investigational drugs to be prepared in the event of a relapse. Her husband died February 12, 2021 with a rare and unexplained occurrence of liver cancer possibly unrelated to AML.

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