Vertebral fracture risk in glucocorticoid-induced osteoporosis: the role of hypogonadism and corticosteroid boluses.
Absorptiometry, Photon
Adolescent
Adrenal Cortex Hormones
/ administration & dosage
Adult
Aged
Aged, 80 and over
Autoimmune Diseases
/ complications
Biomarkers
Bone Density
Cross-Sectional Studies
Disease Susceptibility
Female
Glucocorticoids
/ administration & dosage
Humans
Hypogonadism
/ complications
Male
Middle Aged
Osteoporotic Fractures
/ diagnosis
Rheumatic Diseases
/ complications
Risk Assessment
Risk Factors
Sex Factors
Spinal Fractures
/ diagnosis
Young Adult
Bone Density
Glucocorticoids
Osteoporosis
Journal
RMD open
ISSN: 2056-5933
Titre abrégé: RMD Open
Pays: England
ID NLM: 101662038
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
received:
07
06
2020
revised:
17
07
2020
accepted:
10
08
2020
entrez:
12
9
2020
pubmed:
13
9
2020
medline:
2
7
2021
Statut:
ppublish
Résumé
The aim of this study was to identify the risk factors associated with fragility fracture (FF) development in glucocorticoid (GC)-treated patients. 127 patients (aged 62±18 years, 63% women) on GC-treatment (mean dose 14.5±14.1 mg/day and duration 47.7±69 months) were included. The clinical data collected included bone metabolism study (including gonadal axis), GC-treatment, disease activity, dual-energy X-ray absorptiometry analysis (evaluating densitometric osteoporosis (OP) and trabecular bone score (TBS) degraded microarchitecture values (DMA)), X-ray (assessing vertebral fractures (VF)), FRAX risk (GC-adjusted) and previous FF. 17% of the patients had VF, 28% FF (VF and/or non-VF), 29% OP and 52% DMA. Patients with VF received more GC boluses (57.1% vs 29.5%, p=0.03), were older (68±13 vs 60±19 years, p=0.02), postmenopausal (100% vs 67%, p=0.02), had low testosterone levels (57% vs 11%, p=0.02), lower TBS values (1.119±0.03 vs 1.237±0.013, p<0.001) and higher FRAX risk (17.2±16 vs 9.3±7.6, p=0.003). Patients with FF showed higher accumulated GC doses (16.6±18.4 vs 11.1±12.9 g, p=0.046). On multivariate analysis, hypogonadism (OR 12.38; 95% CI 1.85 to >100, p=0.01) and having received GC boluses (OR 3.45; 95% CI 1.04 to 12.15, p=0.01) were the main factors related to VF. Hypogonadism (OR 7.03; 95% CI 1.47 to 38.37, p=0.01) and FRAX >20 (OR 7.08; 95% CI 1.28 to 53.71, p=0.02) were factors related to FF. Hypogonadism is the principal risk factor for developing fractures in GC-treated men and women, whereas receiving GC boluses is a major factor for VF. These results indicate the importance of evaluating the gonadal axis in these patients.
Identifiants
pubmed: 32917834
pii: rmdopen-2020-001355
doi: 10.1136/rmdopen-2020-001355
pmc: PMC7520700
pii:
doi:
Substances chimiques
Adrenal Cortex Hormones
0
Biomarkers
0
Glucocorticoids
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
J Endocrinol Invest. 2011 Jun;34(6):481-4
pubmed: 21623147
Rev Med Interne. 2003 Jun;24(6):384-8
pubmed: 12814827
Ann Rheum Dis. 2019 Jun;78(6):736-745
pubmed: 30926722
J Clin Med. 2019 Feb 07;8(2):
pubmed: 30736442
J Bone Miner Res. 2014 Mar;29(3):518-30
pubmed: 24443324
Urol Clin North Am. 2016 May;43(2):163-76
pubmed: 27132573
Nat Rev Rheumatol. 2015 Feb;11(2):98-109
pubmed: 25385412
BMC Musculoskelet Disord. 2015 Oct 15;16:300
pubmed: 26472426
Osteoporos Int. 2007 Oct;18(10):1319-28
pubmed: 17566815
J Clin Endocrinol Metab. 2004 Aug;89(8):3651-5
pubmed: 15292281
Joint Bone Spine. 2009 May;76(3):241-7
pubmed: 19196531
Osteoporos Int. 2015 Jun;26(6):1773-80
pubmed: 25743176
Endocrine. 2014 Nov;47(2):435-48
pubmed: 24853880
Eur J Endocrinol. 2015 Sep;173(3):R131-51
pubmed: 25971649
Rev Clin Esp. 2018 Apr;218(3):121-127
pubmed: 29329765
Arthritis Rheum. 2003 Nov;48(11):3224-9
pubmed: 14613287
Curr Osteoporos Rep. 2013 Dec;11(4):276-85
pubmed: 24091896
Joint Bone Spine. 2011 Dec;78 Suppl 2:S214-7
pubmed: 22153674
Arthritis Rheumatol. 2017 Jun;69(6):1272-1279
pubmed: 28141919
RMD Open. 2015 Apr 08;1(1):e000014
pubmed: 26509049
Ann Rheum Dis. 1996 May;55(5):288-93
pubmed: 8660101
J Intern Med. 1993 Sep;234(3):237-44
pubmed: 8354973
Calcif Tissue Int. 2006 Sep;79(3):129-37
pubmed: 16969593
Bone. 2018 Dec;117:83-90
pubmed: 30218790
Mod Rheumatol. 2017 May;27(3):398-404
pubmed: 27484855
J Bone Miner Res. 2016 May;31(5):940-8
pubmed: 26498132
Rheumatology (Oxford). 2020 Jul 1;59(7):1574-1580
pubmed: 31628810
Arthritis Rheumatol. 2017 Aug;69(8):1521-1537
pubmed: 28585373
Medicine (Baltimore). 2017 Nov;96(45):e8661
pubmed: 29137106
J Clin Densitom. 2018 Apr - Jun;21(2):185-192
pubmed: 29102474
Biomed Res Int. 2017;2017:4210217
pubmed: 28127556
Bone. 2015 Sep;78:216-24
pubmed: 25988660
N Engl J Med. 2011 Jul 7;365(1):62-70
pubmed: 21732837
N Engl J Med. 2018 Dec 27;379(26):2547-2556
pubmed: 30586507
Bone. 2008 Dec;43(6):1115-21
pubmed: 18793764
Calcif Tissue Int. 2012 Oct;91(4):225-43
pubmed: 22878667
J Bone Miner Res. 2000 Jun;15(6):993-1000
pubmed: 10841167
Endocrine. 2018 Jul;61(1):7-16
pubmed: 29691807
Bone. 2006 Aug;39(2):253-9
pubmed: 16574519
Apoptosis. 2005 May;10(3):583-95
pubmed: 15909120
J Rheumatol. 2004 Jun;31(6):1083-7
pubmed: 15170918
J Clin Endocrinol Metab. 2009 May;94(5):1671-7
pubmed: 19258412