Background Reports on the prevalence of osteoporosis, osteoporotic fractures and risk factors for osteoporosis in patients with psoriasis (PSO) or psoriatic arthritis (PSOA) are scarce, and the published results on this are, at least in part, contradictory.  Despite the fact that IL-17 is involved in bone homeostasis under both physiologic and pathologic conditions, there is no detailed knowledge of the direct and indirect impact an IL-17 antagonist like secukinumab (SEC) has on bone mineral density (BMD).
Objectives Rh-GIOP (ClinicalTrials.gov Identifier NCT02719314) is an ongoing prospective study monitoring glucocorticoid (GC)-induced osteoporosis of rheumatic patients, established in 2015 at the Charité University Hospital. For this analysis, clinical data and bone mineral density data measured by dual x-ray absorptiometry (DXA) of 936 patients with inflammatory rheumatic diseases provided the basis. The main objective of this cross-sectional analysis was to evaluate the prevalence of osteoporosis and the frequency of fractures in patients with PSO or PSOA. Additionally, patients treated with secukinumab were compared to those with methotrexate (MTX) with regard to BMD, fracture incidence, physical activity, and back pain
Methods We analyzed the initial visit of 103 patients with PSO (n= 31, 74% female) or PSOA (n=72, 64% female). Descriptive analyses were performed, and values are displayed as means and standard deviations. For subgroup analyses non-parametric tests were used.
Results The prevalence of osteoporosis in our patient group (mean age: 62±10 years; 67% female; mean disease duration: 17±13 years) was 19%. The prevalence of osteopenia was 26%, 34% (n=35) reported peripheral fragility fractures, and 11% (n=11) had vertebral fractures in history. Regular physical activity was reported by 41% (n=42), while 53% (n=55) suffered from movement restrictions. Back pain was present in 68% (n=70) of patients with a mean numeric rating scale of 5 (NRS; 0-10). SEC was used by 18% (n=19), and MTX by 42% (n=43, 25% sc, 13% oral, 4% unknown), respectively. Eight percent had a combination therapy of MTX and SEC. Twenty-seven percent used GC and/or other biologics/conventional disease modifying antirheumatic drugs (DMARDs). Mean glucocorticoid cumulative dose (GCCD) was 12.8±22.0g. Patients with SEC showed a significantly longer disease duration (median: 24 years vs. 13 years) compared to MTX, but showed no other differences in baseline-characteristics or risk factors. T-Scores of both femora were significantly higher in the MTX versus the SEC group. We could not find significant differences between these groups with regard to physical activity, back pain, movement restriction, fracture rates or GCCD. Twenty-five percent of the MTX users and 27% of the patients in the SEC group additionally had GC while; in contrast to no patient in the combination group.
Conclusion The prevalence of osteoporosis in patients with PSO or PSOA was found to be as high as in the normal population. However, there was a high frequency of peripheral fragility, but not vertebral fractures. Patients with PSO or PSOA patients treated with SEC had a longer disease duration and lower hip BMD, but showed no differences in back pain, physical activity or movement restrictions compared to MTX users.
Funding: Rh-GIOP is supported by a joint funding of Amgen, BMS, Celgene, Generic Assays, GSK, Hexal, Horizon, Lilly, medac, Mundipharma, Novartis, Pfizer, Roche, and Sanofi.
References  Frediani, B., et al., Bone mineral density in patients with psoriatic arthritis. J Rheumatol, 2001. 28(1): p.138-43.
Disclosure of Interests Desiree Freier: None declared, Edgar Wiebe Grant/research support from: Rh-GIOP is supported by a joint funding of Amgen, BMS, Celgene, Generic Assays, Chugai, Hexal AG, Horizon, Lilly, medac, Mundipharma, Novartis, Pfizer, Roche, and Sanofi., Kim Zeiner: None declared, Robert Biesen: None declared, Thomas Buttgereit: None declared, Sandra Hermann: None declared, Frank Buttgereit: None declared
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