Ali R, et al. - Fifty systemic lupus erythematosus (SLE) children, and 50 age- and sex-matched healthy controls were assessed by the experts in order to evaluate serum osteoprotegerin (OPG), receptor activator of nuclear factor-κB ligand (RANKL) and RANKL/OPG ratio levels in SLE children and controls, to ascertain whether the cumulative glucocorticoid (CGCS) dose had any impact on the concentration of serum RANKL, OPG, and RANKL/OPG ratio, and to discover the relationship of these parameters to BMD. In SLE patients, RANKL, OPG and RANKL/OPG ratio was significantly greater. Notable associations of RANKL with CGCS and with dual-energy x-ray absorptiometry (DXA) scan z-score were found, ie, OPG was significantly related to Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score and anti-double-stranded DNA, whereas RANKL/OPG was significantly associated with the term of illness and DXA z-score. DXA z-score and the SLEDAI score were an independent predictor of RANKL and RANKL/OPG ratio and OPG levels, respectively. BMD was negatively related to disease term and CGCS dose, but no important association could be discovered between BMD and cumulative SLEDAI score. Hence, in Egyptian children with SLE, serum RANKL/OPG ratio was raised and was acknowledged as a risk factor for decreased BMD in these children. Other risk factors for low BMD were high CGCS dose and disease term, maintaining that osteoporosis in SLE was multifactorial.