Effects of glucocorticoids on bone mineral density in rheumatoid arthritis patients

Miyamoto, Sachio; Kageyama, Yasunori; Ozeki, Takehiko; Hiyoshi, Masahide; Suzuki, Masanori; Inoue, Tetsuo

doi:10.1007/s004020050348

Cited by 4 publications

(3 citation statements)

References 10 publications

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“…Thirty-five studies were identified by electronic or manual search, and 13 were selected for full text review based on title/abstract. 7–13,22–26 However, 6 of the 11 were excluded; 4 were nonrandomized studies, 10,22–24 and the other 2 had no BMD data. 25,26 Thus, 7 studies met the inclusion criteria.…”

Section: Resultsmentioning

confidence: 99%

Effects of Low-Dose Corticosteroids on the Bone Mineral Density of Patients with Rheumatoid Arthritis

Lee

Woo

Choi

et al. 2008

Journal of Investigative Medicine

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BackgroundThe effects of long-term high-dose corticosteroids on bone mineral density (BMD) are clear, but the effects of low-dose corticosteroids in patients with rheumatoid arthritis (RA) remain controversial. The aim of this study was to assess the effects of low-dose corticosteroids on BMD in patients with RA.MethodsThe authors surveyed randomized controlled studies that examined the effects of low-dose corticosteroids on BMD in patients with RA using MEDLINE and the Cochrane Controlled Trials Register and by performing manual searches. Data were collected on BMD (end-of-period or change-from-baseline) after longest recorded treatment durations. Meta-analysis was performed using a random effects model; outcomes are presented as standardized mean differences (SMDs).ResultsSeven studies were included in this meta-analysis, which included 7 studies on lumbar BMD meta-analysis and 6 studies on femur BMD meta-analysis. Corticosteroids resulted in a moderate worsening in lumbar BMD compared with controls (SMD = −0.483; 95% confidence interval [CI], −0.815 to −0.151, P = 0.004), whereas the femoral BMD differences were not siginificant (SMD = −0.224; 95% CI, −0.663 to 0.215, P = 0.318). Subgroup analysis of BMD data performed on a change-from-baseline basis showed that corticosteroids had a clear effect on both lumbar and femoral BMDs (SMD = −0.354; 95% CI, −0.620 to −0.088, P = 0.009; SMD = −0.488; 95% CI, −0.911 to −0.065, P = 0.024, respectively).ConclusionsThis meta-analysis shows BMD loss after low-dose corticosteroid treatment in patients with RA. These findings have practical implications for the long-term management of patients with RA on low-dose corticosteroids.

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Section: Resultsmentioning

confidence: 99%

Effects of Low-Dose Corticosteroids on the Bone Mineral Density of Patients with Rheumatoid Arthritis

Lee

Woo

Choi

et al. 2008

Journal of Investigative Medicine

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“…This study (referred to as the General Practice Research Database (GPRD) study) was conducted in a general practice setting in the UK [75][76][77][78][79]. There were a further 29 smaller studies which have also investigated fracture [16,22,30,38,41,52,57,58,68,74,[80][81][82][83][84][85][86][87][88][89][90][91][92][93][94][95][96][97][98]. Six studies were excluded from the analysis due to insufficient information for OR calculation [41,52,80,83,90,96].…”

Section: Results Of Reviewmentioning

confidence: 99%

“…Studies of patients using daily doses on average of 7.5 mg prednisolone or lower at the time of BMD measurement found conflicting results. Several studies found no substantive reductions in BMD at lower doses [15,16,18,26,28,37,39,[54][55][56][57]102,103], in contrast to others [29,30,36,43,47,68,98,105]. Interpretation of these results is complicated because the daily doses used prior to the BMD measurement were frequently unknown and not taken into account.…”

Section: Relationship To Cs Dosementioning

confidence: 96%

The Epidemiology of Corticosteroid-Induced Osteoporosis: a Meta-analysis

Staa

Leufkens

Cooper

2002

Osteoporosis International

1,038

272

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Abstract. Studies of oral corticosteroid dose and loss of bone mineral density have reported inconsistent results. In this meta-analysis, we used information from 66 papers on bone density and 23 papers on fractures to examine the effects of oral corticosteroids on bone mineral density and risk of fracture. Strong correlations were found between cumulative dose and loss of bone mineral density and between daily dose and risk of fracture. The risk of fracture was found to increase rapidly after the start of oral corticosteroid therapy (within 3 to 6 months) and decrease after stopping therapy. The risk remained independent of underlying disease, age and gender. We conclude that oral corticosteroid treatment using more than 5 mg (of prednisolone or equivalent) daily leads to a reduction in bone mineral density and a rapid increase in the risk of fracture during the treatment period. Early use of preventive measures against corticosteroid-induced osteoporosis is recommended.

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Significance of risk factors for osteoporosis is dependent on gender and menopause in rheumatoid arthritis

et al. 2008

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The aim of our study was to compare the significance of risk factors for osteoporosis according to gender and menopausal state in patients with rheumatoid arthritis (RA). Bone mineral density (dual X-ray absorptiometry), cumulative glucocorticoid dose, age, disease duration, body mass index (BMI) and parameters of disease activity and bone turnover were registered in 343 postmenopausal women, 100 premenopausal women and 108 men with RA. Osteoporosis was found in a significantly higher percentage in postmenopausal women (55.7%) and in men (50.5%) in comparison with premenopausal women (18%; P < 0.001). The following risk factors for osteoporosis were found: older age, low BMI and high cumulative glucocorticoid dose in postmenopausal women, low BMI and high cumulative glucocorticoid dose in men and low BMI in premenopausal women. There is a very high prevalence of osteoporosis not only in postmenopausal women but also in men with RA. Osteoporosis risk factors are strongly dependent from gender and menopausal state.

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Effects of glucocorticoids on bone mineral density in rheumatoid arthritis patients

Cited by 4 publications

References 10 publications

Effects of Low-Dose Corticosteroids on the Bone Mineral Density of Patients with Rheumatoid Arthritis

Effects of Low-Dose Corticosteroids on the Bone Mineral Density of Patients with Rheumatoid Arthritis

The Epidemiology of Corticosteroid-Induced Osteoporosis: a Meta-analysis

Significance of risk factors for osteoporosis is dependent on gender and menopause in rheumatoid arthritis

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