Risk factors for multi-joint disease in patients with glucocorticoid-induced osteonecrosis.
Glucocorticoids
Hematologic malignancies
Osteonecrosis
Systemic lupus erythematosus
Journal
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA
ISSN: 1433-2965
Titre abrégé: Osteoporos Int
Pays: England
ID NLM: 9100105
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
received:
21
11
2020
accepted:
01
04
2021
pubmed:
21
4
2021
medline:
15
10
2021
entrez:
20
4
2021
Statut:
ppublish
Résumé
This study investigated risk factors for osteonecrosis involving multiple joints (MJON) among glucocorticoid-treated patients. The best predictor of MJON was cumulative oral glucocorticoid dose. Risk of MJON was 12-fold higher in patients who had a second risk factor for osteonecrosis. Further research is needed into strategies for prevention of MJON. Osteonecrosis (ON) is a debilitating musculoskeletal condition in which bone cell death can lead to mechanical failure. When multiple joints are affected, pain and disability are compounded. Glucocorticoid treatment is one of the most common predisposing factors for ON. This study investigated risk factors for ON involving multiple joints (MJON) among glucocorticoid-treated patients. Fifty-five adults with glucocorticoid-induced ON were prospectively enrolled. MJON was defined as ON in ≥ three joints. Route, dose, duration, and timing of glucocorticoid treatment were assessed. Mean age of enrolled subjects was 44 years, 58% were women. Half had underlying conditions associated with increased ON risk: systemic lupus erythematosus (29%), acute lymphoblastic leukemia (11%), HIV (9%), and alcohol use (4%). Mean daily oral dose of glucocorticoids was 29 mg. Average cumulative oral dose was 30 g over 5 years. The best predictor of MJON was cumulative oral glucocorticoid dose. For each increase of 1,000 mg, risk of MJON increased by 3.2% (95% CI 1.03, 1.67). Glucocorticoid exposure in the first 6 months of therapy, peak dose (oral or IV), and mean daily dose did not independently increase risk of MJON. The risk of MJON was 12-fold in patients who had a second risk factor (95% CI 3.2, 44.4). Among patients with glucocorticoid-induced ON, cumulative oral dose was the best predictor of multi-joint disease; initial doses of IV and oral glucocorticoids did not independently increase risk. Further research is needed to better define optimal strategies for prevention and treatment of MJON.
Identifiants
pubmed: 33877383
doi: 10.1007/s00198-021-05947-x
pii: 10.1007/s00198-021-05947-x
pmc: PMC8056829
doi:
Substances chimiques
Glucocorticoids
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2095-2103Informations de copyright
© 2021. International Osteoporosis Foundation and National Osteoporosis Foundation.
Références
World J Orthop. 2015 Sep 18;6(8):590-601
pubmed: 26396935
Leuk Lymphoma. 2000 May;37(5-6):635-7
pubmed: 11042527
J Bone Joint Surg Br. 2008 Sep;90(9):1239-43
pubmed: 18757967
Int Orthop. 2016 Apr;40(4):669-72
pubmed: 26630885
Br J Clin Pharmacol. 2003 Mar;55(3):264-9
pubmed: 12630976
Pediatr Blood Cancer. 2005 Mar;44(3):220-5
pubmed: 15514916
JAMA. 2020 Oct 6;324(13):1330-1341
pubmed: 32876694
J Orthop Sci. 2016 Jul;21(4):407-413
pubmed: 27062553
J Oral Maxillofac Surg. 2016 Feb;74(2):292-301
pubmed: 26296596
J Bone Joint Surg Am. 2006 May;88(5):1117-32
pubmed: 16651589
Thromb Res. 2020 Jul;191:145-147
pubmed: 32291094
Chir Organi Mov. 2008 Sep;92(2):119-22
pubmed: 18473129
Eur J Orthop Surg Traumatol. 2020 Feb;30(2):193-197
pubmed: 31538269
Orthopedics. 2014 Jul;37(7):e631-6
pubmed: 24992058
Am J Med. 1985 Nov;79(5):596-604
pubmed: 4061472
Medicine (Baltimore). 2016 Jun;95(25):e3981
pubmed: 27336899
J Arthroplasty. 2019 Jan;34(1):169-174.e1
pubmed: 30348559
JBJS Rev. 2020 Jul;8(7):e2000052
pubmed: 32759612
J Autoimmun. 2020 Jun;110:102460
pubmed: 32307211
Thromb Res. 2020 Jul;191:148-150
pubmed: 32381264
Arthritis Care Res (Hoboken). 2013 Feb;65(2):294-8
pubmed: 22807233
BMJ Paediatr Open. 2017 Sep 11;1(1):e000122
pubmed: 29637145
N Engl J Med. 1992 May 28;326(22):1473-9
pubmed: 1574093
Rheumatology (Oxford). 2011 Nov;50(11):2023-8
pubmed: 21865285
Autoimmun Rev. 2010 Sep;9(11):721-43
pubmed: 20621176
Osteoporos Int. 2017 Mar;28(3):1027-1034
pubmed: 27844132
Bone Joint J. 2014 Feb;96-B(2):259-62
pubmed: 24493194
Perm J. 2019;23:
pubmed: 30939270
Gene. 2018 Sep 10;671:103-109
pubmed: 29859289
J Rheumatol. 2006 Aug;33(8):1701-4
pubmed: 16881128
J Rheumatol. 1998 Oct;25(10):1968-74
pubmed: 9779852
BMC Musculoskelet Disord. 2019 Jan 15;20(1):23
pubmed: 30646869
Endocrine. 2012 Apr;41(2):183-90
pubmed: 22169965
J Orthop Sci. 2009 Nov;14(6):794-800
pubmed: 19997828
J Clin Oncol. 2000 Sep 15;18(18):3262-72
pubmed: 10986059
Clin Orthop Relat Res. 1999 Dec;(369):312-26
pubmed: 10611887
Bone Joint J. 2013 Nov;95-B(11 Suppl A):46-50
pubmed: 24187351
Blood. 2015 Oct 8;126(15):1770-6
pubmed: 26265699
J Pediatr Hematol Oncol. 2014 Jan;36(1):22-9
pubmed: 24136019
West Afr J Med. 2006 Jan-Mar;25(1):82-3
pubmed: 16722366
BMJ Case Rep. 2018 Nov 1;2018:
pubmed: 30389732
S Afr Med J. 1993 Sep;83(9):646-9
pubmed: 8310355
PLoS One. 2016 Mar 11;11(3):e0151433
pubmed: 26967741
J Steroid Biochem Mol Biol. 2009 Apr;114(3-5):121-8
pubmed: 19429441
Orthop Rev (Pavia). 2012 May 9;4(2):e17
pubmed: 22802985