Assessment of bone mineral density by dual x-ray absorptiometry in dermatological patients treated by corticosteroids

Abstract

Background:Corticosteroids are mainstay of dermatological therapy and they are also a well known cause of osteoporosis. The objective of the present study was to find out the influence of the systemic intake of corticosteroids, either by the oral route or by IV pulse administration, on bone mineral density in dermatological patients using dual X-ray absorptiometry (DXA).Materials and Methods:This study was carried on 100 patients and 55 controls. The first group of patients included 55 patients undergoing long-term oral corticosteroid therapy daily and the second group included 45 patients who received IV dexamethasone pulse therapy. DXA was measured once for both the controls and patients in group 1. DXA was measured twice for patients in group 2, before starting pulse therapy (baseline DXA) and six months after regular treatment with pulse therapy (follow-up DXA).Results:The results show that significant reduction in BMD occurs in both groups, however, oral corticosteroids produce significantly more reduction in BMD in the lumbar spine. BMD was not found to be affected by the cumulative doses of corticosteroids, the duration of daily oral corticosteroid intake, or the number of IV dexamethasone pulses.Conclusion:Corticosteroid treatment causes significant BMD loss in patients treated by either route. Prophylactic treatment against osteoporosis is mandatory in patients receiving either form of corticosteroids.

Epidemiology of Idiopathic Inflammatory Myopathies in Africa

“…As depicted in Figure 1, 39 of 9918 identified records were included 13–51 . Studies were conducted in 19 countries between 1958 and 2019.…”

“…Dermatomyositis was reported in 17 studies 13,20,21,24–26,29–31,33,34,37,42,43,45,48,51 (Supplementary Tables S5, http://links.lww.com/RHU/A286). The frequency of DM varied from 21% in a retrospective cross-sectional study from Nigeria involving 14 patients with IIMs 30 to 93% in the aforementioned cohort from South Africa involving 15 patients with IIMs 13…”

“…13,16,18,20,22,[24][25][26]28,30,32,36,41,44,48,51 Glucocorticoids were consistently the first-line treatment across studies and prescribed to all patients in 14 of these. 13,20,22,[24][25][26]28,30,32,36,41,44,48,51 Methotrexate and azathioprine were preferred glucocorticoid-sparing agents in 10 16,25,26,30,32,36,41,44,48,51 and 8 studies, 16,25,26,32,36,41,48,51 respectively. In methotrexate/azathioprine nonrespondents, intravenous immunoglobulins (IVIGs) and rituximab were prescribed at frequencies of 19.2% and 3.8%, respectively, in the largest series of IIMs.…”

“…Drug treatments were reported in 16 nonexperimental studies. 13,16,18,20,22,[24][25][26]28,30,32,36,41,44,48,51 Glucocorticoids were consistently the first-line treatment across studies and prescribed to all patients in 14 of these. 13,20,22,[24][25][26]28,30,32,36,41,44,48,51 Methotrexate and azathioprine were preferred glucocorticoid-sparing agents in 10 16,25,26,30,32,36,41,44,48,51 and 8 studies, 16,25,26,32,36,41,48,51 respectively.…”

A Statistical Approach Regarding the Diagnosis of Osteoporosis and Osteopenia From DXA: Are We Underdiagnosing Osteoporosis?

“…In particular, the correlation structure between DXA measurements of BMD at different sites (L1-L4, femoral neck and total hip) are likely clinically relevant. For example, it is known that corticosteroid use preferentially affects and decreases lumbar spine BMD relative to the femoral neck and total hip BMD [19,20]. Therefore, the correlation structure between BMD measurements at different sites for patients treated with corticosteroids is likely different from that in the young untreated adult population.…”