The use of long-term corticosteroids to control SLE activity has detrimental effects on bone health, leading to decreased bone mass (24). This is of particular concern in the adolescent, as adolescence and young adulthood are an important time to develop optimal peak bone mass (25). In adults, a low bone mineral density (BMD) is associated with an increase in risk for osteoporotic fractures. Although the magnitude of the fracture risk for adolescents with low BMD due to SLE and steroid treatment is not known, it is a concern for long-term morbidity. Current strategies employed are to measure BMD with dual energy X-ray absorptiometry and to encourage supplemental calcium and vitamin D. The use of bisphosphonates in adolescents is controversial at the present time (see Chapter 12).
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