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Objectives To describe the prevalence of osteoporosis (OP), fragility fractures, and osteoporosis treatment patterns in a cohort of patients with systemic lupus erythematosus (SLE). Methods A retrospective analysis was conducted in SLE patients (2019 EULAR/ACR criteria) followed at a tertiary hospital. Demographic, clinical, and treatment data were collected, including BMD results, history of fragility fractures, osteoporosis treatment, and traditional risk factors for bone loss.Results A total of 99 SLE patients were included (90% female). The mean age was 55.5 years (±15.3), the mean age at SLE diagnosis was 40.8 (±18.5) years, and the mean disease duration was 14.3 (±10.4) years. Overall, 37.8% of patients had OP based on BMD results, and 26.3% were receiving antiresorptive or anabolic therapy ( table 1), although 3 patients who were without antiresorptive treatment had received it previously and were on therapeutic vacation period (2 teriperatide and 1 denosumab). Among classical risk factors, 12.1% were smokers (5% former and 82% never smokers), 99% reported no alcohol consumption, 57% of women were postmenopausal, 25% had an associated osteopenic condition, and 17.5% were taking other osteopenic medications. Antiresorptive or anabolic therapy in SLE patients was independently associated with longer disease duration (P<0.001), older age at diagnosis (P<0.001), presence of an osteopenic condition (P=0.006), and chronic active glucocorticoid use (P=0.018). Although the use of osteopenic medications did not reach statistical significance for association with antiresorptive or anabolic therapy, a trend was observed. Postmenopausal status and use of immunosuppressants did not significantly influence osteoporosis treatment in this cohort.Abstract PO:12:323 Table 1Conclusions Osteoporosis and osteopenia are highly prevalent among patients with SLE, yet a large proportion remain untreated with antiresorptive or anabolic therapies. Optimising bone health management and addressing modifiable risk factors should be a priority in the comprehensive care of SLE patients. In our cohort, osteoporosis treatment was more common among patients with longer disease duration, older age at diagnosis, chronic glucocorticoid use, and concomitant osteopenic conditions.