PURPOSE OF REVIEW The article reviews recent advances in the research of fractures in patients with systemic lupus erythematosus (SLE), highlighting their clinical, scientific, and economic impact. RECENT FINDINGS Recent studies demonstrated an increased incidence of osteoporosis and symptomatic fractures in patients with SLE and age, disease duration, disease severity, and glucocorticoid use are important risk factors. A high prevalence of vertebral fractures was demonstrated, while one in three of these patients has normal bone density, which illustrates the multifactorial cause of fractures in SLE. Screening for vertebral fractures is important, as they often occur asymptomatically, but are associated with a reduced quality of life, increased future fracture risk, an increased mortality risk, and may have therapeutic implications. A recently developed Delphi consensus revealed the high economic burden of fractures as a glucocorticoid-related adverse event in SLE, whereas the majority of patients use glucocorticoids. SUMMARY Recent studies revealed an increased incidence of symptomatic fractures and a relatively high prevalence of vertebral fractures in patients with SLE, and provided new insights into their multifactorial aetiology. The clinical consequences and high economic burden of fractures as glucocorticoid-related adverse events underline the importance of reducing glucocorticoid therapy and use of steroid-sparing agents.