Bone turnover markers, BMD and TBS after short-term, high-dose glucocorticoid therapy in patients with Graves’ orbitopathy: a small prospective pilot study

Censi, Simona; Manso, Jacopo; Pandolfo, G; Franceschet, Giulio; Cavedon, Elisabetta; Zhu, Yi Hang; Carducci, Sofia; Gomiero, Walter; Plebani, Mario; Zaninotto, Martina; Watutantrige-Fernando, Sara; Mian, Caterina; Camozzi, Valentina

doi:10.1007/s40618-018-0992-z

Cited by 9 publications

(14 citation statements)

References 29 publications

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“…Our findings are consistent with previous studies, that showed that 1 week of treatment with 60 mg of daily prednisone decreased CTX levels, and even lower doses (10 mg of daily prednisone over 1-2 weeks) decreased CTX levels by 10% [23]. Another study investigating the effects of short-term, high-dose corticosteroid treatment on BTMs reported a significant decrease in CTX levels 1 month after commencing treatment [22].…”

Section: Discussionsupporting

confidence: 92%

“…Interestingly, we found that CTX levels began to recover after 1 month in both treatment groups, although some patients in both groups received additional corticosteroid courses during the follow-up period. This trend in serum CTX levels was also observed in other studies [ 15 , 22 ] and may reflect the change in dosage or a skeletal adaptation to corticosteroids.…”

Section: Discussionsupporting

confidence: 86%

“…Other studies have reported suppression of bone formation in response to long-term treatment with low-moderate doses of prednisolone, which was reflected by decreased P1NP levels [ 15 , 22 ]. We were not able to reproduce these results in our study.…”

Section: Discussionmentioning

confidence: 99%

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Bone turnover biomarkers in COPD patients randomized to either a regular or shortened course of corticosteroids: a substudy of the randomized controlled CORTICO-COP trial

et al. 2020

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Background Long-term treatment with corticosteroids causes loss of bone density, but the effects of using short-term high-dose systemic-corticosteroid therapy to treat acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are unclear. Our aim was to determine whether high-dose corticosteroid therapy affected bone turnover markers (BTMs) to a greater extent compared to low-dose corticosteroid therapy. Methods The CORTICO-COP trial (NCT02857842) showed that an eosinophil-guided corticosteroid intervention led to approximately 60% lower accumulated corticosteroid dose for hospitalized patients with AECOPD (low-dose group) compared with 5-day standard corticosteroid treatment (high-dose group). We compared the levels of BTMs C-terminal telopeptide of type 1 collagen (CTX) and procollagen type 1 N-terminal propeptide (P1NP) in 318 participants during AECOPD and at 1- and 3-month follow-up visits. Results CTX decreased and P1NP increased significantly over time in both treatment groups. There were no significant differences between the groups at 1- or 3-months follow-up for P1NP. A significant drop in CTX was seen at 3 months (down Δ24% from the baseline, p = 0.017) for the high dose group. Conclusion Short-term, high-dose systemic corticosteroid treatment caused a rapid suppression of biomarkers of bone resorption. Corticosteroids did not suppress biomarkers of bone formation, regardless of patients receiving low or high doses of corticosteroids. This therapy was, therefore, harmless in terms of bone safety, in our prospective series of COPD patients. Trial registration ClinicalTrials.gov Identifier: NCT02857842. Submitted August 2nd, 2016.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 86%

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Bone turnover biomarkers in COPD patients randomized to either a regular or shortened course of corticosteroids: a substudy of the randomized controlled CORTICO-COP trial

et al. 2020

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“…Studies on short‐term (<3 months) exposure to glucocorticoids have been conflicting. Adults (median age: 56 years) receiving glucocorticoids for Graves' orbitopathy did not demonstrate persistent effects on bone turnover, BMD or trabecular bone score (TBS) 36 while adults aged 18–55 years prescribed glucocorticoids for chronic fatigue syndrome had low BMD 37 . A meta‐regression analysis of randomized‐controlled trials (RCTs) comparing the effect of glucocorticoid exposure at initiation (≤6 months of use) versus chronic use (>6 months; mean daily dose of 4–15 mg) compared with nonusers demonstrated a 5.1% and 2.5% increased incidence of vertebral and nonvertebral fracture in glucocorticoid‐initiators, respectively.…”

Section: Gio and Risk Of Fracturementioning

confidence: 99%

“…C‐terminal telopeptide of type 1 collagen (CTx) levels, however, were not reduced, postulated to be due to the initial anti‐inflammatory effect of glucocorticoids in RA 80 . In a cohort of patients with Graves' orbitopathy, administration of methylprednisolone did not lead to changes in P1NP levels, although a significant reduction in CTx levels were noted at 1 month 36 . In glucocorticoid naïve men aged 20–30 years with newly diagnosed with SLE, osteocalcin levels were suppressed and CTx levels were elevated; changes to these BTMs correlated directly and indirectly, respectively, with disease activity 112 .…”

Section: Denosumabmentioning

confidence: 99%

Challenges in the diagnosis and management of glucocorticoid‐induced osteoporosis in younger and older adults

Herath

Langdahl

Ebeling

et al. 2021

Clinical Endocrinology

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Objective Glucocorticoids constitute a considerable risk for developing osteoporosis in both younger and older adults. However, currently available bone imaging modalities and fracture‐risk assessment tools do not adequately capture the dramatic changes in bone microarchitecture, heterogeneity of glucocorticoid exposure, the impact of chronic disease and other osteoporosis risk factors on the assessment of osteoporosis in these individuals. Design A narrative review is presented, following a systematic search of the literature from 2000 to 2021. Results Our current appreciation of glucocorticoid‐induced osteoporosis (GIO) is focused on older populations, with limited evidence to guide the investigation, risk assessment and treatment in premenopausal women and men less than 50 years. The impact of the underlying chronic disease on secondary osteoporosis in these younger adults is also poorly understood. Conclusion Through this narrative review, we provide a comprehensive overview of and recommendations for optimising the management of this common cause of secondary osteoporosis younger and older adults.

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Bone turnover decreases and bone structure improves during treatment with weekly high-dose methylprednisolone for 12 weeks in Graves’ orbitopathy

Harsløf,

Hikmet,

Ebbehøj

et al. 2023

Endocrine

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Purpose Weekly treatment with the intravenous glucocorticoid methylprednisolone for 12 weeks is mainstay in the treatment of Graves’ orbitopathy but may decrease bone mass and impair bone structure. We therefore investigated bone turnover, -mass and -structure during the treatment cause in these patients. Methods We included 32 patients with Graves’ orbitopathy scheduled for treatment with methylprednisolone. Bone turnover and thyroid function was measured at baseline and after 3, 9, 12, and 24 weeks, bone mineral density (BMD) was measured using dual x-ray absorptiometry at baseline and after 12 and 24 weeks, and bone structure was measured using high-resolution peripheral quantitative computed tomography at baseline and after 12 weeks. Results Bone turnover and tri-iodothyronine decreased throughout the study. Cortical volumetric BMD at both the radius and tibia increased significantly by 0.98 ± 0.38% (p = 0.01) and 1.35 ± 0.50% (p = 0.01), respectively and cortical porosity at both the radius and tibia decreased significantly by −7.67 ± 3.13% (p = 0.04) and −3.30 ± 2.17% (p = 0.04), respectively. Bone mineral density was stable during the first 12 weeks but increased significantly by 2.26 ± 3.61% at the femoral neck (p < 0.01) and by 2.24 ± 4.24% at the total hip towards week 24 (p = 0.02). Stratified analyses suggested that remission of hyperthyroidism was the most important determinant of changes in bone turnover, bone mass and structure. Conclusion During a 12-week course of high-dose intravenous methylprednisolone bone turnover and cortical porosity decreased and during 24 weeks follow up bone mineral density increased. In terms of bone, methylprednisolone therefore is a safe treatment for Graves’ orbitopathy.

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Bone turnover markers, BMD and TBS after short-term, high-dose glucocorticoid therapy in patients with Graves’ orbitopathy: a small prospective pilot study

Cited by 9 publications

References 29 publications

Bone turnover biomarkers in COPD patients randomized to either a regular or shortened course of corticosteroids: a substudy of the randomized controlled CORTICO-COP trial

Bone turnover biomarkers in COPD patients randomized to either a regular or shortened course of corticosteroids: a substudy of the randomized controlled CORTICO-COP trial

Challenges in the diagnosis and management of glucocorticoid‐induced osteoporosis in younger and older adults

Bone turnover decreases and bone structure improves during treatment with weekly high-dose methylprednisolone for 12 weeks in Graves’ orbitopathy

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