Risk of vertebral fracture and relationship to bone mineral density in steroid treated rheumatoid arthritis.

Abstract

Objectives-To determine the prevalence of vertebral fracture in postmenopausal women with steroid treated rheumatoid arthritis (RA), and whether the risk of vertebral fracture could be predicted from measurements of bone mineral density (BMD).Methods-Vertebral deformities were defined from spine radiographs in 76 postmenopausal women with steroid treated RA (aged 50-79 years) and 347 age matched women from a population based group, using a morphometric technique. Lumbar spine (LS) BMD was measured by dual energy x ray absorptiometry. Results-The odds ratio for vertebral fracture in the women with RA was 6-2 (95% confidence interval 3*2 to 12-3). The decrease in LS-BMD was less than expected for the observed prevalence of vertebral fracture and, among the women with RA, LS-BMD was not lower in those with vertebral fractures. Conclusions-We conclude that patients with steroid treated RA may have abnormal bone quality, and that LS-BMD cannot be used to predict the risk of vertebral fracture in these patients.

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

“…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.…”

“…Other studies have published conflicting results on individual susceptibility to fractures. Naganathan et al [52] observed a higher increase in vertebral deformities in older users compared to younger users, whereas Peel et al [57] observed the converse.…”

“…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].…”

“…Peel et al [57] found that there was a six-fold increase in the risk of vertebral deformity in CS users compared with controls, but only a 0.79 SD reduction in lumbar spine BMD. Table 2 shows the relationship between BMD changes and increases in risk of fracture.…”

Clinical utilities of quantitative ultrasound in osteoporosis associated with inflammatory rheumatic diseases

“…In rheumatoid arthritis patients, treated with GC, the risk of vertebral fracture has been reported as having increased 6-fold compared with controls, whereas the reduction of lumbar spine BMD was only 0.79 SD (50). A recent meta-analysis on glucocorticoid-induced osteoporosis revealed that fractures occur at a much higher rate than expected on the basis of BMD, and that BMD changes during GC therapy may predict, only to a moderate extent, the increase in fracture risk (49).…”