Bisphosphonates, Plus Vitamin D, May Help Prevent Heart Disease in SLE Patients

A combination treatment of bisphosphonate and vitamin D may prevent cardiovascular disease in patients with systemic lupus erythematosus (SLE), a new study shows.

The study, “Effect of combined treatment with bisphosphonate and vitamin D on atherosclerosis in patients with systemic lupus erythematosus: a propensity score-based analysis,” was published in the journal Arthritis Research & Therapy.

Due to the progress made in the treatment of SLE, cardiovascular disease has replaced lupus-related organ failure as the main cause of morbidity and mortality in these patients.

Lupus patients have several risk factors for atherosclerosis, a disease in which plaque builds up inside arteries and blocks blood flow. So, preventing atherosclerosis is a major concern in patients with SLE.

Several studies have shown there is a biological link between atherosclerosis and osteoporosis, which is a bone disease that occurs when the body either loses bone, makes too little bone, or both.

Vitamin D helps prevent osteoporosis by helping the body absorb calcium, and bisphosphonate therapy is often prescribed to patients with osteoporosis. Vitamin D and bisphosphonates also are frequently prescribed to patients with lupus, as most require anti-osteoporotic treatment during long-term glucocorticoid use.

However, their effect on atherosclerosis is unknown, though it could be hypothesized that anti-osteoporotic treatment helps prevent atherosclerosis.

Researchers set out to explore the correlation between the development of atherosclerosis and anti-osteoporotic treatment in a group of SLE patients.

Researchers retrospectively analyzed 117 patients with SLE who underwent carotid artery ultrasonography, a technique used to determine degree of atherosclerosis.

Patients received either vitamin D alone (30 patients), bisphosphonates alone (27 patients) or a combination of both (42 patients).

Results indicated that fewer patients in the combination group had carotid plaques compared with the other groups. In fact, these patients were 75 percent less likely to develop carotid plaques.

Statistical analysis also showed that age was associated with the presence of carotid plaques, which means the older the patient, the higher the chance of developing carotid plaque.

“This study provides some preliminary evidence to support the use of combination therapy with bisphosphonates and vitamin D to prevent atherosclerosis in patients with SLE,” investigators concluded.

Theoretically, “the anti-atherosclerotic effect of a triple combination of statins, bisphosphonates and vitamin D may be more promising but was not well-evaluated herein due to the relatively small sample size.” As a result, further studies focusing on the effect of all three treatments are warranted.