An Italian cohort study in women observed an increased fracture risk in rheumatoid arthritis and other inflammatory diseases, which was independent of treatment with corticosteroids.
“We all know that glucocorticoid-induced osteoporosis is the most common form of secondary osteoporosis and is associated with an increased risk of fragility fracture,” stated Dr Giovanni Adami (University of Verona, Italy). “However, we use glucocorticoids in several inflammatory diseases and, currently, the independent role of the inflammation or glucocorticoid use on fracture risk in such patients is still unknown,” he continued to explain the motivation for the current retrospective, observational cohort study.
Data was collected from the Italian web-based nationwide tool for fracture risk assessment, DeFRAcalc. The analysis was performed by propensity score matching in a cohort of 59,950 women, ~10,000 of them suffering from comorbidities including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), psoriatic arthritis, chronic obstructive pulmonary disease (COPD), and neurologic diseases. Among these, SLE and RA were most commonly linked to the use of glucocorticoids.
The mean age of study subjects was 65.1 in those not taking glucocorticoids and 65.3 in the group that took ≥5 mg of the glucocorticoid prednisone for >3 months. The BMI in these 2 groups was 24.19 and 24.92, respectively. The analysis adjusted for age, bone mineral density, menopausal status, and family history of fragility fractures. The overall risk of vertebral or hip fracture had an adjusted odds ratio (aOR) of 1.56 for patients using glucocorticoids for >3 months compared with non-users. Interestingly, even for participants <40 years of age with >3 months of glucocorticoid use, this fracture risk was increased by ~30% (aOR 1.31). For non-vertebral/non-hip fractures the all age aOR was 1.24.
In addition, independent associations for fractures and certain diseases were identified: COPD and neurological disease were linked to both vertebral and non-vertebral fractures, while RA was associated with non-vertebral, non-hip fractures. These associations were independent of bone mineral density and glucocorticoid intake. The results indicate the deleterious effects that systemic inflammation exerts on the bone. According to Dr Adami, this means that there is no such thing as a safe glucocorticoid dose in RA patients.
- Adami G, et al. Risk of Fracture in Patients with Different Glucocorticoid Requiring Diseases. P0120, ACR Convergence 2020 Virtual Annual Meeting, 5-9 November 2020.