medwireNews: Low glucocorticoid doses are not associated with reduced bone mineral density (BMD) in people with inflammatory rheumatic and musculoskeletal diseases (RMDs), observational study findings indicate.
However, results from the Rh-GIOP study also revealed that current use of glucocorticoids at a dose of more than 7.5 mg/day was significantly associated with reduced BMD, as measured by T-scores, but only in people with rheumatoid arthritis (RA) and moderate-to-high disease activity (DAS28–CRP >3.2 points).
“In other words, doses of 5 mg/day or above did not seem to be associated with lower T-scores in patients [with RA] either in remission or with low disease activity,” write Frank Buttgereit (Charité – Universitätsmedizin Berlin, Germany) and co-authors in the Annals of the Rheumatic Diseases.
Indeed, a specific analysis of individuals with RA receiving 5 mg/day of glucocorticoids (n=138) showed no negative impact on BMD at any disease activity level.
In all, the study included 1066 patients (mean age 62 years, 76% women) with an inflammatory RMD. Of these, 41% had RA, 26% had connective tissue diseases, 17% had spondyloarthritides, including psoriatic arthritis, and 16% had vasculitidies. Median C-reactive protein levels were in the normal range, at 2.3 mg/L, and the mean DAS28–CRP was 2.7 points in people with RA.
At baseline, 66% of participants were current glucocorticoid users, taking a median dose of 5 mg/day. Just under half (49%) had osteopenia and 22% had osteoporosis; 31% had fragility fractures.
The researchers found that in both unadjusted and adjusted analyses, glucocorticoid doses of less than 5 mg/day, as well as cumulative dose and duration of glucocorticoid therapy, were not associated with decreased BMD.
For higher glucocorticoid doses, there was a negative association with BMD in unadjusted analyses, but this was attenuated after accounting for age, sex, menopause status, BMI, disease duration, alkaline phosphatase levels, and the use of denosumab and bisphosphonates.
DMARD use in the whole cohort, and seropositivity for anticitrullinated protein antibodies and rheumatoid factor in the people with RA, were also not significantly associated with BMD.
Buttgereit and co-authors conclude that glucocorticoids “should be used in an optimum dose, titrated with both benefit and harm in mind, in order to achieve remission and to support bone health” in people with inflammatory RMDs.
They add that “at these low dosages, the anti-inflammatory effects of [glucocorticoids] can potentially counter their negative effects on BMD.”
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