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Osteoporosis
Optimising both disease control and glucocorticoid dosing is essential for bone protection in patients with rheumatic disease
  1. Edgar Wiebe1,
  2. Dörte Huscher2,
  3. Désireé Schaumburg1,
  4. Andriko Palmowski1,
  5. Sandra Hermann1,
  6. Thomas Buttgereit3,4,
  7. Robert Biesen1,
  8. Gerd-Rüdiger Burmester1,
  9. Yannick Palmowski5,
  10. Maarten Boers6,
  11. John H Stone7,
  12. Christian Dejaco8,9,
  13. Frank Buttgereit1
  1. 1Department of Rheumatology and Clinical Immunology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
  2. 2Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
  3. 3Department of Dermatology, Venerology and Allergology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Berlin, Germany
  4. 4Institute of Allergology, Charité, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Berlin, Germany
  5. 5Center for Musculoskeletal Surgery, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
  6. 6Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands
  7. 7Vasculitis and Glomerulonephritis Center, Rheumatology, Immunology and Allergy Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  8. 8Rheumatology, Medical University of Graz, Graz, Austria
  9. 9Rheumatology, Brunico Hospital (SABES-ASDAA), Brunico, Italy
  1. Correspondence to Professor Frank Buttgereit, Department of Rheumatology and Clinical Immunology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; frank.buttgereit{at}charite.de

Abstract

Objectives Inflammatory rheumatic and musculoskeletal diseases (iRMDs) are associated with increased systemic bone loss that is mediated by chronic inflammation, treatment with glucocorticoids (GCs) and other factors. Our objective was to analyse the impact of variables that influence osteoporosis (OP) in patients with iRMD treated with GC.

Methods Rh-GIOP (acronyme) is a prospective observational cohort study investigating bone health in consecutive patients with iRMD and current or prior GC treatment. We present an analysis of the patients’ baseline data here. Bone mineral density (BMD) measured by dual X-ray absorptiometry was the primary outcome. Multivariable linear regression models were performed to identify variables associated with BMD.

Results Data from 1066 patients with iRMD were analysed. GC doses of <5 mg prednisone equivalent per day, cumulative dose and duration of GC therapy were not associated with negative effects on BMD. Dosages of ≥5 mg/day lost their negative association with BMD after adjustment for confounders. When subanalysing patients with exactly 5 mg/day, no negative effect was seen. For patients with rheumatoid arthritis (RA), GC doses of >7.5 mg/day showed a negative association with BMD overall, but this effect seemed to be specific only to patients with moderate or high disease activity (Disease Activity Score 28–C reactive protein >3.2).

Conclusions GCs of ≤5 mg/day did not seem to be associated with a reduction of BMD in patients with iRMD and current or prior exposure to GC. This is most likely due to the dampening of inflammation by GC, which exerts a mitigating effect on the risk of OP. In RA, current GC doses of >7.5 mg/day were negatively associated with BMD, but only in patients with moderate to high disease activity.

Trial registration number NCT02719314.

  • glucocorticoids
  • osteoporosis
  • outcome assessment, health care
  • arthritis, rheumatoid

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/annrheumdis-2022-222339

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Handling editor Josef S Smolen

    • Contributors We declare that all authors included on this paper fulfil the criteria of authorship. Concept and planning: FB, EW, DH and CD; supervision: FB; conduct/data collection: EW, DS, SH, TB, RB, GRB, YP and FB; data analyses: FB, EW, DH, CD, MB, G-RRB and JHS; visualisation: FB, EW, DH and CD; writing (draft): FB, EW, DH, AP, CD, MB, GRB and JHS; writing and approving (final manuscript): all authors. Guarantor: FB

    • Funding Rh-GIOP (acronyme) was supported by a joint funding of Amgen, Biogen, BMS, Chugai, Generic Assays, GSK, Hexal, Horizon Therapeutics, Lilly, Medac, Mundipharma, Novartis, Pfizer, Roche and Sanofi-Genzyme.

    • Competing interests EW reported consultancy fees, honoraria and travel expenses from Medac and Novartis. DH reported receiving travel expenses from Shire. TB received consultancy fees and honoraria from Roche, Novartis, Sanofi and GSK. RB reported receiving consultancy fees, honoraria and travel expenses from Novartis. GRB reported receiving consultancy fees, honoraria and travel expenses from Roche and Sanofi and grant support from Medac. MB received consulting fees from Novartis. JS reported receiving consulting fees from AbbVie, ChemoCentryx, Sanofi, Spruce, Zenas, Bristol-Myers Squib, Sana, Q32Bio, Novartis, Kyverna, Horizon, Steritas and Argenx. CD reported receiving consultancy fees and honoraria from MSD, Pfizer, UCB, AbbVie, Roche, Novartis, Lilly, Sanofi and Galapagos. FB reported receiving consultancy fees, honoraria and travel expenses from Abbvie, Horizon Therapeutics, Pfizer and Roche, and grant support from Horizon Therapeutics, Roche and Abbvie.

    • Patient and public involvement Patients and/or the public were involved in the design, conduct, reporting or dissemination plans of this research. Refer to the Methods section for further details.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.