Evaluation of risk factors of vertebral fracture in Japanese female patients with glucocorticoid-induced osteoporosis

Abstract Background Glucocorticoid-induced osteoporosis and vertebral fracture are common complications in patients on glucocorticoid treatment for rheumatological diseases. The present study aimed to identify the risk factors of vertebral fracture in Japanese female patients with glucocorticoid-induced osteoporosis.Methods This study included 225 Japanese women with glucocorticoid-induced osteoporosis and 72 patients with postmenopausal osteoporosis. All participants were treated with bisphosphonate or denosumab for osteoporosis with active form of vitamin D for at least 3 years. The differences of clinical parameters, including age, disease duration, body mass index (BMI), bone mineral density (BMD), and the dose and treatment duration of glucocorticoid were assessed between patients with and without vertebral fracture. Multivariate logistic regression analysis was also performed to evaluate the association of vertebral fracture with clinical parameters.Results The significant differences related to age, BMD of the hip, disease duration, glucocorticoid treatment duration between patients with and without vertebral fractures were demonstrated. The present study indicated that disease duration, BMI, and the total hip BMD were independent risk factors for vertebral fractures in patients with glucocorticoid-induced osteoporosis.Conclusions Prolonged disease duration, low BMI, and low total hip BMD could be risk factors of vertebral fracture in patients on glucocorticoid treatment for rheumatological diseases.

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Age Dependence of Early Symptomatic Vertebral Fracture with High-Dose Glucocorticoid Treatment for Collagen Vascular Diseases

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2008-1578 ◽

2009 ◽

Vol 94 (5) ◽

pp. 1671-1677 ◽

Cited By ~ 34

Author(s):

Ichiro Tatsuno ◽

Takao Sugiyama ◽

Sawako Suzuki ◽

Tomohiko Yoshida ◽

Tomoaki Tanaka ◽

...

Keyword(s):

Vertebral Fracture ◽

Vertebral Fractures ◽

Treatment Duration ◽

Vascular Diseases ◽

High Dose ◽

Glucocorticoid Treatment ◽

Collagen Vascular Diseases ◽

Kaplan Meier ◽

Hazard Ratios ◽

Younger Age

Abstract Objectives: Collagen vascular diseases requiring treatment with high-dose glucocorticoids are frequently complicated by vertebral fracture. We investigated the incidence of symptomatic vertebral fractures for 20 yr among patients who were treated with high-dose glucocorticoids in the Chiba-Shimoshizu Rheumatic Cohort. Methods: A total of 2631 patients with collagen vascular diseases (aged ≥18 yr) was registered between 1986 and 2006. The prevalence of symptomatic vertebral fracture was compared between the high-dose glucocorticoid group newly treated with high-dose glucocorticoids (≥20 mg/d prednisolone equivalent) (n = 700), and the non-glucocorticoid controls not treated with glucocorticoids (n = 194). Results: During the 20-yr study period, symptomatic vertebral fractures occurred more frequently in the high-dose glucocorticoid group (23.9%) than in the non-glucocorticoid controls (2.6%). According to a Kaplan-Meier analysis, the cumulative incidence of symptomatic vertebral fracture was significantly higher in the high-dose glucocorticoid group than in the non-glucocorticoid controls (P < 0.001). Stratified into age quartiles of the high-dose glucocorticoid group (age 18–31, 32–47, 48–59, and 60–88 yr), the patients had a markedly increased incidence of symptomatic vertebral fracture with aging. The hazard ratios were also significantly higher in the older age quartile of 60–68 than in the younger age quartile of 32–47 (P < 0.001 for trend). The hazard ratio was 26-fold higher in patients aged 60–88 than in patients aged 18–31 (P < 0.01). In the group with fractures, the treatment duration before fracture was negatively associated with the initial age (r = −0.6587; P < 0.001). Conclusions: The prevalence of symptomatic vertebral fractures was higher in the patients treated with high-dose glucocorticoids than the untreated controls. Vertebral fractures were age dependent in patients treated with high-dose glucocorticoids. Treatment duration before fracture incidence was significantly shorter in the older patients.

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AB1065 Prevalence and Risk Factors of Vertebral Fractures in Women with Rheumatoid Arthritis Using Vertebral Fracture Assessment (VFA)

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2015-eular.1383 ◽

2015 ◽

Vol 74 (Suppl 2) ◽

pp. 1256.1-1256

Author(s):

M. Djennane ◽

H. Djoudi ◽

S. Salah

Keyword(s):

Rheumatoid Arthritis ◽

Risk Factors ◽

Vertebral Fracture ◽

Vertebral Fractures ◽

Vertebral Fracture Assessment ◽

Fracture Assessment

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Prevalence and incidence of osteoporotic fractures in patients on long-term glucocorticoid treatment for rheumatic diseases: the Glucocorticoid Induced OsTeoporosis TOol (GIOTTO) study

Reumatismo ◽

10.4081/reumatismo.2017.922 ◽

2017 ◽

Vol 69 (1) ◽

pp. 30 ◽

Cited By ~ 12

Author(s):

M. Rossini ◽

O. Viapiana ◽

M. Vitiello ◽

N. Malavolta ◽

G. La Montagna ◽

...

Keyword(s):

Risk Factors ◽

Vertebral Fractures ◽

Chronic Treatment ◽

Randomized Clinical Trials ◽

Real Life ◽

Connective Tissue Diseases ◽

Specific Treatment ◽

Osteoporotic Fractures ◽

Mineral Density ◽

Glucocorticoid Treatment

Osteoporosis and fractures are common and invalidating consequences of chronic glucorticoid (GC) treatment. Reliable information regarding the epidemiology of GC induced osteoporosis (GIOP) comes exclusively from the placebo group of randomized clinical trials while observational studies are generally lacking data on the real prevalence of vertebral fractures, GC dosage and primary diagnosis. The objective of this study was to evaluate the prevalence and incidence of osteoporotic fractures and to identify their major determinants (primary disease, GC dosage, bone mineral density, risk factors, specific treatment for GIOP) in a large cohort of consecutive patients aged >21 years, on chronic treatment with GC (≥5 mg prednisone - PN - equivalent) and attending rheumatology centers located all over Italy. Glucocorticoid Induced OsTeoporosis TOol (GIOTTO) is a national multicenter cross-sectional and longitudinal observational study. 553 patients suffering from Rheumatoid Arthritis (RA), Polymyalgia Rheumatica (PMR) and Connective Tissue Diseases (CTDs) and in chronic treatment with GCs were enrolled. Osteoporotic BMD values (T score <-2.5) were observed in 28%, 38% and 35% of patients with CTDs, PMR or RA at the lumbar spine, and in 18%, 29% and 26% at the femoral neck, respectively. Before GC treatment, prevalent clinical fractures were reported by 12%, 37% and 17% of patients with CTDs, PMR, or RA, respectively. New clinical fragility fractures during GC treatment were reported by 12%, 10% and 23% of CTDs, PMR and RA patients, respectively. Vertebral fractures were the prevailing type of fragility fracture. More than 30% of patients had recurrence of fracture. An average of 80% of patients were in supplementation with calcium and/or vitamin D during treatment with GCs. Respectively, 64%, 80%, and 72% of the CTDs, PMR and RA patients were on pharmacological treatment for GIOP, almost exclusively with bisphosphonates. The GIOTTO study might provide relevant contributions to clinical practice, in particular by highlighting and quantifying in real life the prevalence of GIOP and relative fractures, the frequency of the main risk factors, and the currently sub-optimal prevention. Moreover, these results emphasize the importance of the underlying rheumatic disease on the risk of GIOP associated fractures.

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Risk of spontaneous vertebral fracture during bisphosphonates drug holiday

Egyptian Rheumatology and Rehabilitation ◽

10.1186/s43166-020-00027-0 ◽

2020 ◽

Vol 47 (1) ◽

Author(s):

Ahmed Aboughanima

Keyword(s):

Vertebral Fracture ◽

Femoral Neck ◽

Vertebral Fractures ◽

Significant Group ◽

Fracture Group ◽

Total Hip ◽

Time Interaction ◽

Osteoporotic Vertebral Fractures ◽

Hip Bmd ◽

History Of

Abstract Background Bisphosphonates are the most common treatment for osteoporosis with confirmed efficacy. However, less information is available on prolonged use. This study was performed to examine the risk of osteoporotic vertebral fractures during bisphosphonates holiday and estimate its predictors. Results Forty-two patients completed 2-year fracture-free holiday; 7 had spontaneous vertebral fracture. Among baseline characteristics, age was significantly higher in fracture group (69.99 ± 3.62 vs. 75.37 ± 3.81; P value 0.007); other factors were comparable. Longitudinal changes analysis showed that only alkaline phosphatase (ALP) increment had significant group over time interaction (P value 0.002). The difference between baseline and clinical end-point serum collagen type 1 cross-linked C-telopeptid (CTX) was significant in both fracture and non-fracture groups, whereas femoral neck and total hip BMD decline was significant in fracture group only. Multivariate analysis showed that only age (OR, 1.43; p, 0.011) and history of previous fractures (OR, 13.59; p, 0.044) are significant predictors of vertebral fractures. Conclusions These results suggest that older age and history of previous fracture should be considered as risk factors for vertebral fractures during bisphosphonates holiday. Furthermore, femoral neck and total hip BMD decline could be related to vertebral fractures. By the same token, overt increase of ALP and CTX could be an indicator of fracture occurrence.

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