2022ACR: Effects of glucocorticoids and anti-osteoporotic therapy on inflammatory rheumatic musculoskeletal disease

One GLORIA trial conducted a debate
surrounding the benefits of glucocorticoids in inflammatory diseases in older age.
884 women with inflammatory rheumatic musculoskeletal disease and 1766 controls were included in the study and followed for 6 years
.
Significant reductions in bone mineral density levels were found in all users of glucocorticoids who did not receive anti-osteoporosis therapy, Figure 1
.

The researchers conducted a longitudinal cohort study
of women with inflammatory rheumatic musculoskeletal disorders.
Glucocorticoid intake was recorded
from 0 to 2.
5 mg/day effective dose, ≥5 mg/day predicted dose.
Inflammatory rheumatic musculoskeletal disorders include: rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), psoriatic arthritis (PsA), systemic sclerosis, and other rheumatic diseases (vasculitis, multiple rheumatoid arthritis, spondyloarthritis, etc.
).

Bone mineral density and fractures were prospectively assessed and compared
with the Healthy Women Cohort (PSM).

Anti-osteoporotic therapy was found to increase bone mineral density levels to a greater extent in patients receiving prednisone less than 5 mg/day
.
A total of 21, 12 and 29 fractures were reported in patients receiving ≥ 5 mg/day, 2.
5 mg to 5 mg and 0~2.
5 mg/day, corresponding to rough fracture rates of 4.
8 cases per 100 person-years, 2.
8 cases per 100 person-years and 2.
5 cases per 100 person-years
, respectively.
103 fractures
were registered in the PSM cohort.
Patients with inflammatory rheumatic musculoskeletal disorders had a higher
incidence of fractures compared to controls.
With glucocorticoids ≥ 5 mg/day and all other doses, the risk of any type of fracture was 2 times
higher compared to the control group.
The Kaplan-Meier curve
for the cumulative incidence of fractures is reported in Figures 2 and 3.

In inflammatory rheumatic musculoskeletal diseases, glucocorticoid doses as low as 2.
5 mg/day are associated with loss of bone mineral density levels, an effect that can be prevented
with anti-osteoporotic drugs.
This finding may support anti-osteoporotic therapy
in patients taking very low doses of glucocorticoids.

Author: K.
K

Resources:

https://acrabstracts.
org/abstract/impact-of-glucocorticoid-dosing-and-anti-osteoporotic-treatment-on-bone-health-in-patients-with-inflammatory-rheumatic-musculoskeletal-diseases-a-longitudinal-cohort-study/