Global prevalence, site-specific patterns, and key risk factors for osteoporosis and bone loss in systemic lupus erythematosus: a systematic review and meta-analysis
Abstract
Background: Systemic lupus erythematosus (SLE) is a complex autoimmune disease in which patients have a significantly increased risk of developing osteoporosis (OP) and osteopenia. Despite numerous studies, the global burden of SLE-related OP, its regional distribution patterns and its major risk factors remain poorly quantified and subject to controversy due to heterogeneity in sample sizes, diagnostic criteria and methodologies. To address these gaps in the evidence, we conducted a systematic assessment of the prevalence and risk factors for OP and osteopenia in patients with SLE.
Methods: We conducted a systematic review and meta-analysis. We performed a comprehensive search of Chinese and English databases, including PubMed, Embase, the Cochrane Library, Web of Science, CNKI and WANFANG, up to 26 September 2025. We included observational studies that met the diagnostic criteria for SLE and reported the prevalence of OP or reduced bone mass, as well as associated risk factors. Two reviewers independently conducted literature screening, data extraction and quality assessment. Statistical analysis was performed using Stata 12.0 software; random-effects or fixed-effects models were employed to pool prevalence rates and odds ratios, and subgroup analysis, meta-regression and sensitivity analysis were used to explore sources of heterogeneity.
Results: A total of 59 studies were included. Meta-analysis revealed an overall prevalence of osteoporosis in SLE patients of 16.70%…
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