{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T13:33:23Z","timestamp":1790948003156,"version":"4.1.0"},"reference-count":69,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T00:00:00Z","timestamp":1770768000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"\n Background<\/jats:title>\n Osteonecrosis of the femoral head (ONFH) is a severe complication of systemic lupus erythematosus (SLE). However, the demographic characteristics, glucocorticoids (GCs) risks, and other contributing factors remain debated.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To elucidate the population characteristics, GCs-related risks, and other risk factors for ONFH in patients with SLE through a systematic review and meta-analysis, thereby enhancing the clinical identification of high-risk populations and optimizing GCs therapy strategies in SLE.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We searched seven databases, from their inception until July 2025 for relevant cohort and case-control studies. The quality of included studies was assessed using the Newcastle-Ottawa Scale. Meta-analysis was performed using RevMan 5.3.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Thirty-five studies involving 11,356 participants were included. Regarding population characteristics, patients with SLE who developed ONFH had a significantly younger age at diagnosis (SMD = -0.19,\n P<\/jats:italic>\n &lt; 0.00001) and higher SLEDAI scores (SMD = 0.21,\n P<\/jats:italic>\n = 0.002). Among metabolic and immune indicators, elevated triglycerides (SMD = 0.21,\n P<\/jats:italic>\n = 0.02), decreased high-density lipoprotein cholesterol (SMD = -0.22,\n P<\/jats:italic>\n = 0.03), and positive antiphospholipid antibodies (OR = 2.00,\n P<\/jats:italic>\n = 0.04) were associated with ONFH occurrence. Regarding GC therapy, pulse steroid therapy (OR = 2.02,\n P<\/jats:italic>\n &lt; 0.00001), an initial dose &gt;60 mg\/day (OR = 4.19, P &lt; 0.0001), a maximum daily dose &gt;50 mg (SMD = 0.42,\n P<\/jats:italic>\n = 0.0002), and higher average daily GC intake (SMD = 0.32,\n P<\/jats:italic>\n = 0.004) significantly increased ONFH risk. In contrast, cumulative GC dose showed no significant association (\n P<\/jats:italic>\n = 0.14). Furthermore, vasculitis (OR = 3.17,\n P<\/jats:italic>\n &lt; 0.00001), hypertension (OR = 1.48,\n P<\/jats:italic>\n = 0.02), Raynaud\u2019s phenomenon (OR = 1.60,\n P<\/jats:italic>\n = 0.0003), thrombocytopenia (OR = 1.69,\n P<\/jats:italic>\n = 0.007), and arthritis (OR = 1.88,\n P<\/jats:italic>\n = 0.006) were identified as independent risk factors.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Patients with SLE at high risk for ONFH exhibit distinct characteristics. Short-term high-dose GC exposure, rather than cumulative dose, constitutes the core medication-related risk. Enhanced imaging screening and comprehensive, multi-factorial prevention strategies are warranted, particularly for patients receiving high initial doses or pulse therapy. Clinical management should focus on optimizing GC regimens in these high-risk individuals to minimize the occurrence of ONFH.<\/jats:p>\n <\/jats:sec>\n \n Systematic review registration<\/jats:title>\n \n https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420251084371<\/jats:ext-link>\n , identifier CRD420251084371.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1755818","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T06:52:11Z","timestamp":1770792731000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Population characteristics, glucocorticoid dosage, and risk factors for osteonecrosis of the femoral head in systemic lupus erythematosus: a Systematic Review and meta-analysis"],"prefix":"10.3389","volume":"17","author":[{"given":"Jiawen","family":"Zhang","sequence":"first","affiliation":[{"name":"The Third Affiliated Hospital of Beijing University of Chinese 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