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Objectives 1) Explore potential risk factors related to low BMD in women with SLE.2) Prospectively examine whether baseline low BMD in women with SLE is associated with later fractures and MACEs, after adjustment for other risk factors.<FILE IMAGE=’387_20251030160150.jpg’>Methods Female patients from the Karolinska SLE cohort who underwent hip and lumbar spine dual energy X-ray absorptiometry (DXA) within the first year after cohort inclusion were included. BMD was classified as normal, osteopenia or osteoporosis according to WHO criteria. Baseline data were collected at the inclusion visit by a rheumatologist and a nurse. Patient data were linked to national registries to identify fractures and MACEs during follow-up using ICD-10 codes (MACE ICD-codes included: I10-16, I20-25, I46-52, I60-69, I70-73, I21, I23, I60-69, excluded: I51.4, I60, I62, I67.1, I68.2, I67.5.). Fatal events (ischemic heart disease, arrythmia, heart failure, cerebrovascular disease, aortic aneurysm, and sudden death) as well as non-fatal myocardial infarction and stroke were included as MACE. Patients with previous fractures and MACEs were excluded. Logistic regression models were applied to analyze potential risk factors associated with the occurrence of any of the described events during follow-up.Results 324 patients (145 postmenopausal, 179 premenopausal) were included. Mean age was 45.7 ± 14.8 years and mean disease duration 12.7 ± 11.8 years. At baseline, 55 patients (17%) were classified to haveosteoporosis, and 143 (44.1%) to have osteopenia. Baseline osteoporosis and osteopenia showed similar patterns of association: they were significantly, or borderline significantly positively associated with age and longer corticosteroid treatment but negatively associated with BMI ( table 1). During follow-up (median 12.4 [IQR 8.65] years for fractures, 14.9 [IQR 8.17] years for MACEs), 91 fractures and 32 MACEs occurred. In multivariable analysis osteoporosis at baseline was the only significant predictor of experiencing a fracture (OR 2.35, 95% CI 1.57–3.53, p<0.001). Longer corticosteroid treatment remained independently associated with experiencing a MACE (table 2).Abstract PO:03:087 Table 1–2Conclusions Osteoporosis at baseline was a strong predictor of fractures, while osteopenia was not significantly associated. Smoking and longer duration of corticosteroid treatment increased the risk of presenting with MACEs, though the effect of smoking was of borderline significance (p=0.051). Low BMD was not a predictor of MACE.