Статті в журналах: "Glucocorticoids, rheumatic diseases, osteoporosis, fractures"

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Evstigneeva, L. P. "Osteoporosis in rheumatic diseases." Medical alphabet, no. 33 (December 13, 2021): 64–75. http://dx.doi.org/10.33667/2078-5631-2021-33-64-75.

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The article presents a review of studies that have examined osteoporosis in rheumatic diseases, including rheumatoid arthritis, spondylarthritis, psoriatic arthritis, systemic connective tissue diseases, and systemic vasculitis. The review discusses the pathogenesis, diagnosis and treatment of osteoporosis in these diseases, presents the results of epidemiological studies assessing the risk factors and the prevalence of osteoporosis in rheumatic diseases. There was a high prevalence of osteoporosis and fractures in rheumatic diseases, exceeding the population, associated primarily with systemic and local inﬂammation, as well as with the intake of glucocorticoids. It is indicated that the existing strategies for the treatment of rheumatic diseases may partially reduce bone loss, but long-term administration of glucocorticoids, on the contrary, increase bone resorption. The review presents data on the medications for the treatment of osteoporosis and approaches to the treatment of glucocorticoid osteoporosis.

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Nowakowska-Płaza, Anna, Jakub Wroński, Iwona Sudoł-Szopińska, and Piotr Głuszko. "Clinical Utility of Trabecular Bone Score (TBS) in Fracture Risk Assessment of Patients with Rheumatic Diseases Treated with Glucocorticoids." Hormone and Metabolic Research 53, no. 08 (August 2021): 499–503. http://dx.doi.org/10.1055/a-1528-7261.

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AbstractChronic glucocorticoid therapy is associated with osteoporosis and can cause fractures in up to 50% of patients. Increased risk of fractures in patients with glucocorticoid-induced osteoporosis does not result only from the decreased bone mineral density (BMD) but also bone microarchitecture deterioration. Trabecular bone score (TBS) is a method complementary to DXA, providing additional information about trabecular bone structure. The aim of this study was to assess the clinical utility of TBS in fracture risk assessment of patients treated with glucocorticoids. Patients with rheumatic diseases treated with glucocorticoids for at least 3 months were enrolled. All recruited patients underwent DXA with additional TBS assessment. We analyzed the frequency of osteoporosis and osteoporotic fractures and assessed factors that might be associated with the risk of osteoporotic fractures. A total of 64 patients were enrolled. TBS and TBS T-score values were significantly lower in patients with osteoporosis compared to patients without osteoporosis. Low energy fractures occurred in 19 patients. The disturbed bone microarchitecture was found in 30% of patients with fractures without osteoporosis diagnosis based on BMD. In the multivariate analysis, only TBS and age were significantly associated with the occurrence of osteoporotic fractures. TBS reflects the influence of glucocorticoid therapy on bone quality better than DXA measured BMD and provides an added value to DXA in identifying the group of patients particularly prone to fractures.

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Kozyreva, M. V., O. A. Nikitinskaya, and N. V. Toroptsova. "Trabecular bone score in rheumatic disease." Rheumatology Science and Practice 60, no. 6 (December 25, 2022): 587–93. http://dx.doi.org/10.47360/1995-4484-2022-587-59.

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Patients with rheumatic diseases (RD) are at high risk of osteoporosis (OP) and osteoporotic fractures. The Trabecular bone score (TBS) is a relatively novel method of assessing bone quality, which independently predicts fracture risk regardless of bone mineral density (BMD). A lower TBS in patients with RD compared to controls is shown in most studies concerning TBS and RD. The data obtained indicate that TBS predicts fractures better in RD, especially in patients receiving glucocorticoids, than BMD or the FRAX algorithm. TBS degradation has been associated with disease activity in ankylosing spondylitis, systemic sclerosis, and rheumatoid arthritis in a few studies. However, there is little data in the literature on the effect of rheumatic disease therapy and OP treatment in patients with RD on predictive ability of TBS for incident fracture.

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Gladkov, E. N., E. V. Kozhemyakina, L. P. Evstigneeva, V. A. Tikhonova, L. N. Kamkina, O. V. Bannykh, V. M. Balueva, and O. M. Lesnyak. "OSTEOPOROSIS AND ASSOCIATED FRACTURES IN OLDER PATIENTS WITH INFLAMMATORY RHEUMATIC DISEASES." Osteoporosis and Bone Diseases 18, no. 2 (December 15, 2015): 9–14. http://dx.doi.org/10.14341/osteo201529-14.

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Aim. To estimate the burden of fractures in patients with rheumatic inflammatory diseases. Materials and Methods. A specially designed questionnaire was introduced to patients of rheumatic department of Sverdlovsk regional hospital № 1. The study included 242 patients aged 50 to 79 years (mean age 58.4± 6.5 years, 194 women and 48 men). Results. High incidence of osteoporosis (35.5%) was observed in patients with rheumatic inflammatory diseases. Intervention threshold (FRAX) was identified in 46.8% of patients. Low-energy fractures of the skeleton were identified in 33.9% of patient. Oral glucocorticoid therapy increased the risk (odds ratio (95% confidence interval (95% CI)) of osteoporotic fractures by 2.68-fold (95% CI 1.55 - 4.63, p=0.004). Conclusion. High incidence of osteoporosis and osteoporotic fractures was observed in patients with rheumatic inflammatory diseases.

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Rossini, M., O. Viapiana, M. Vitiello, N. Malavolta, G. La Montagna, S. Maddali Bongi, O. Di Munno, et al. "Prevalence and incidence of osteoporotic fractures in patients on long-term glucocorticoid treatment for rheumatic diseases: the Glucocorticoid Induced OsTeoporosis TOol (GIOTTO) study." Reumatismo 69, no. 1 (May 22, 2017): 30. http://dx.doi.org/10.4081/reumatismo.2017.922.

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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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Adami, G., A. Fassio, A. Giollo, G. Orsolini, O. Viapiana, D. Gatti, and M. Rossini. "SAT0456 REAL-LIFE RISK OF FRACTURE AND TREATMENT PREVALENCE IN DRUG-INDUCED OSTEOPOROSIS IN ITALY USING A NEW ALGORITHM." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1185.1–1186. http://dx.doi.org/10.1136/annrheumdis-2020-eular.2565.

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Background:Glucocorticoid-induced osteoporosis and osteoporosis induced by adjuvant hormone therapy for breast cancer are the most common forms of secondary osteoporosis.Objectives:The exact real-life prevalence of treatment with anti-osteoporotic drugs in women with drug-induced osteoporosis is not known. In the present study, using a new mathematical and computerized algorithm, we investigate the profile of risk of fracture of women with drug-induced osteoporosis and the prevalence of treatment with anti-osteoporotic drugs.Methods:We have retrospectively analyzed the 10-year risk of major osteoporotic fracture calculated with the DeFRAcalc79 tool in postmenopausal women aged over 50 years that were initiating an anti-osteoporotic treatment (fully reimbursed according to the Nota 79). DeFRAcalc79 is a new web-based fracture risk-assessment tool (https://defra-osteoporosi.it) that arithmetically adjusts the risk based on multiple risk factors contemplated by the Nota 79, which regulates the reimbursability for osteoporosis medications in Italy (Italian Agency for Drugs, AIFA), including demographic and anthropometric data, femoral and/or lumbar spine BMD T-score, family history of femoral or vertebral fractures, number and site of previous osteoporotic fracture (including vertebral, femoral, and non-vertebral non-femoral fractures), glucocorticoid treatment (> 3 or > 12 months, ≥5 mg prednisone or equivalent), adjuvant hormone therapy for breast cancer, and comorbidities that induce an increased risk of fracture (rheumatoid arthritis and other connective tissue diseases, chronic obstructive pulmonary disease, inflammatory bowel diseases, Parkinson’s disease, multiple sclerosis, human immunodeficiency virus infection, diabetes, or severe physical handicap). This is a sub-analysis of the cross-sectional observational study to validate and further develop the DeFRA algorithm for the estimation of the risk of osteoporotic fractures, promoted by Verona hospital with the unconditional support of Amgen Srl.Results:Among 208 women, 116 (55.8%) were treated with adjuvant hormone therapy for breast cancer and 92 (44.2%) were on glucocorticoid ≥5 mg/day. Women on glucocorticoids had a greater mean 10-year risk of fracture compared to women on adjuvant hormone therapy for breast cancer (67.0% vs 39.1% p<0.01). 50.7% of women on adjuvant hormone therapy for breast cancer used denosumab, 28.0% zoledronic acid and 17.3% alendronate. In glucocorticoid-induced osteoporosis, 17.6% of the women used teriparatide, 37.3% alendronate, 29.4% zoledronic acid and 13.7% denosumab.Conclusion:In our cohort of patients, treatment with adjuvant hormone therapy for breast cancer was slightly more common than glucocorticoids. Women with glucocorticoid-induced osteoporosis had a greater risk of fracture compared to patients treated with adjuvant hormone therapy for breast cancer. Half of the patients on adjuvant hormone therapy for breast cancer were prescribed with denosumab. One-fifth of the patients with glucocorticoid-induced osteoporosis was treated with teriparatide. DeFRAcalc79 is a useful and practical tool for the integrated evaluation of fracture risk in drug-induced osteoporosis.Disclosure of Interests:Giovanni Adami: None declared, Angelo Fassio Speakers bureau: Angelo Fassio reports personal fees from: Abiogen and Novartis, outside the submitted work., Alessandro Giollo: None declared, Giovanni Orsolini: None declared, Ombretta Viapiana: None declared, Davide Gatti Speakers bureau: Davide Gatti reports personal fees from Abiogen, Amgen, Janssen-Cilag, Mundipharma, outside the submitted work., Maurizio Rossini Speakers bureau: AbbVie, Abiogen, Amgen, BMS, Eli-Lilly, Novartis, Pfizer, Sanofi, Sandoz and UCB

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Adami, G., D. Gatti, A. Giollo, E. Bertoldo, O. Viapiana, P. Olivi, A. Fassio, and M. Rossini. "OP0112 FACTORS ASSOCIATED WITH OSTEOPOROSIS CARE OF MEN: A REAL-LIFE STUDY ON A NATION-WIDE DATASET." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 62.1–62. http://dx.doi.org/10.1136/annrheumdis-2021-eular.257.

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Background:Male osteoporosis is associated with an important clinical and economic burden worldwide. Notwithstanding that, undertreatment of men with osteoporosis is common. Understanding the factors associated with less osteoporosis care utilization might help define future intervention to improve access of men to osteoporosis care.Objectives:The aim of the study was to describe the factors associated with osteoporosis care in men.Methods:We conducted a retrospective analysis of a nation-wide cohort (DeFRACalc79 database). DeFRACalc79 is a tool that estimates the fracture risk considering clinical and densitometric risk factors, including the presence of prior hip or vertebral and non-vertebral or non-hip fractures. We compared the clinical characteristics of male individuals with an age matched cohort of women. Propensity score generation with 2:1 matching for female and male patients was performed matching the cohorts for age, generating propensity estimates with a logistic regression model.Results:We analyzed a sample of 4,902 men at high risk of osteoporosis. We found that the factors associated to osteoporosis care utilization in men were: the presence of comorbidities (OR 1.939, 95% CI 1.799-2.090), adjuvant hormonal therapy for prostate cancer (OR 1.482, 95% CI 1.315-1.670), the presence of vertebral or hip fractures (OR 1.490, 95% CI 1.378-1.611) and glucocorticoid treatment (OR 2.573, 95% CI 2.274-2.832) (Table 1)Table 1.Clinical and densitometric characteristics of the study population and age-matched cohort of womenMen (n=4,902)Women (n=9,804)OR (95% CI) – p valueAge (±SD)65.1 (±14.2)65.1 (±14.2)NSBMI (±SD)25.31 (±4.91)24.07 (±4.85)<0.0001Lumbar spine T-score (±SD)-2.13 (±1.37)-2.51 (±1.15)<0.0001Osteoporosis at lumbar spine (%)2,601 (53.1%)5,948 (60.7%)0.733 (0.684-0.785)Femoral neck T-score (±SD)-1.93 (±1.04)-2.19 (±0.91)<0.0001Osteoporosis at femoral neck (%)1,412 (28.8%)3,936 (40.1%)0.603 (0.560-0.649)% 10-year risk of fracture (±SD)22.77 (±21.05)20.26 (±4.85)<0.0001Family history of fragility fracture (%)891 (18.2%)2,379 (24.3%)0.693 (0.636-0.756)Secondary osteoporosis (%)2,415 (49.3%)3,092 (31.5%)2.108 (1.965-2.262)Glucocorticoids ≥5 mg/day >3 months (%)768 (17.4%)694 (7.7%)2.573 (2.274-2.832)Glucocorticoids ≥5 mg/day ≥3 months <12 months (%)74 (2.0%)72 (0.9%)2.357 (1.700-3.267)Glucocorticoids ≥5 mg/day ≥12 months (%)119 (3.2%)138 (1.6%)1.977 (1.543-2.534)Adjuvant hormonal therapy for breast cancer or prostate cancer (%)495 (12.0%)766 (8.4%)1.482 (1.315-1.670)Comorbidities (%)1,778 (36.3%)2,225 (22.7%)1.939 (1.799-2.090)Rheumatoid arthritis (%)303 (8.8%)511 (6.3%)1.439 (1.241-1.668)Psoriatic arthritis (%)59 (1.9%)103 (1.3)1.390 (1.006-1.919)Systemic lupus erythematosus (%)22 (0.7%)77 (1.0%)0.693 (0.431-1.115)Systemic sclerosis (%)9 (0.3%)60 (0.8%)0.364 (0.180-0.734)Other rheumatic diseases (%)173 (5.2%)310 (3.9%)1.354 (1.119-1.638)Inflammatory bowel diseases (%)144 (2.7%)126 (1.6%)2.773 (2.175-3.534)Chronic obstructive pulmonary disease (%)281 (8.3%)277 (3.5%)2.461 (2.074-2.920)Diabetes (%)441 (12.4%)478 (5.9%)2.238 (1.954-2.564)Neurological diseases (%)236 (7.0%)260 (3.3%)2.202 (1.837-2.639)HIV infection (%)110 (3.4%)23 (0.3%)11.603 (7.389-18.221)Vertebral or hip fractures (%)1,434 (29.3%)2,130 (21.7%)1.490 (1.378-1.611)Non-vertebral, non-hip fractures (%)534 (10.9%)1,477 (15.1%)0.689 (0.620-0.766)Conclusion:We found that men accessed osteoporosis care with more severe osteoporosis and/or with a diagnosis of secondary osteoporosis. Male osteoporosis remains largely underdiagnosed with a dramatic latency in osteoporosis care utilization compared to women.Disclosure of Interests:None declared

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Buehring, Bjoern, Friederike Thomasius, Katharina Schultz, and Uwe Maus. "Osteoporosis and Rheumatoid Arthritis-Diagnosis, Diagnostics and Therapy." Osteologie 30, no. 04 (November 2021): 326–34. http://dx.doi.org/10.1055/a-1648-4414.

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AbstractMany inflammatory rheumatic diseases are associated with an increased fracture risk. Causes include the pro-inflammatory cytokines which are elevated in these diseases, reduced mobility and physical activity often caused by joint pain, and medications that negatively affect bone quality. Osteoporosis, the loss of bone mass and structure is the result. This review article summarizes the current diagnostic and therapeutic osteoporosis recommendations for patients with rheumatoid arthritis. It should be emphasized that early measures for the detection and treatment of osteoporosis are particularly important, since the risk factor constellation often present in this patient population leads to a relatively high imminent fracture risk at the beginning of the disease and the start of glucocorticoid therapy. Treatment initiations as early as possible with effective control of inflammatory activity is therefore essential to reduce the risk of osteoporosis. The administration of glucocorticoids should be reduced as far as the clinical context allows. Fracture risk should be assessed when the RA diagnosis is made and in regular intervals thereafter. Osteoporosis medication should be initiated based on the overall fracture risk. The choice of medication is based on the particular risk and indication. The basis of therapy is an adequate intake of vitamin D and calcium and adapted physical activity

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Dobrovolskaya, O. V., N. V. Dyomin, A. V. Smirnov, I. A. Shornikova, and N. V. Toroptsova. "Bone mineral density in women of reproductive age with rheumatic diseases." Medical alphabet 2, no. 37 (January 20, 2020): 7–11. http://dx.doi.org/10.33667/2078-5631-2019-2-37(412)-7-11.

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The article is devoted to the study of bone mineral density (BMD) in women of reproductive age suffering from rheumatic diseases (RD). A survey was conducted of 134 women — 94 patients with RD (rheumatoid arthritis, systemic scleroderma and psoriatic arthritis) and 40 people without RD. Reduced BMD was detected significantly more often in the group of patients with RE compared with the healthy control (25 and 8 %, respectively; p = 0.0213). Patients with RD showed a direct association of BMD values in all measurement areas with height, weight, body mass index, serum vitamin D concentration, and the reverse — with a cumulative dose of glucocorticoids; For MPC of the proximal femur, an additional relationship was revealed with the duration of RD. Thus, a quarter of women with RD in reproductive age need to be monitored, and in the presence of fractures, treatment of osteoporosis.

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Dobrovolskaya, O. V., A. O. Efremova, N. V. Demin, and N. V. Toroptsova. "Bone mineral density and fracture risk in patients with rheumatic diseases." Meditsinskiy sovet = Medical Council, no. 8 (July 16, 2020): 120–27. http://dx.doi.org/10.21518/2079-701x-2020-8-120-127.

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Introduction: Decrease in bone mineral density (BMD) and risk of fractures in rheumatic diseases (RD) is caused by the pathogenetic mechanisms underlying RD and the effects of drugs used to treat them on bone.Aim of the study: to assess the condition of BMD, frequency and risk of fractures in postmenopausal women with different RD.Material and methods: The study enrolled 260 women in postmenopause (median age 61 years) (54; 68 year) with systemic scleroderma (SS), rheumatoid arthritis (RA) and osteoarthritis (OA). Patients were sanitized and examined using dual energy X-ray absorptiometry; a 10-year risk of fractures was calculated using the FRAX® algorithm.Results: A reduced BMD was observed in 210 (81%) women with RD, while osteoporosis (OP) was found in 43% of women with SS, 31% of women with RA and 17% of women with OA. In all RD, osteoporosis was more common in the lumbar spine than in the proximal femur. The frequency of low-energy fractures in the anamnesis was 35, 29 and 20 percent for those with SS, RA and OA, respectively. The most frequent fractures among women with SS and RA were vertebral fractures, and in patients with OA - forearm fractures. The 10-year risk of new fractures according to FRAX® and the need for antiosteoporotic treatment in women with OA was less than in patients with SS and RA (p < 0.0001). Of all patients examined, 44% needed pathogenetic antiosteoporotic therapy, and in actual practice 25% of women received it. Patients with RA were most often treated with zoledronic acid, alendronate and parenteral form of ibandronate.Conclusions: The frequency of OPs and the 10-year risk of fractures in autoimmune RD was significantly higher than in OA. The structure of low-energy fractures in RD is different: in autoimmune processes and glucocorticoids (GC) intake, spinal compression fractures were significantly more common. Pathogenetic treatment for OP in women in post-menopause with RD is not performed frequently enough, which may cause repeated low-energy fractures.

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Hmamouchi, I., F. Paruk, S. A. A. Tabra, K. Maatallah, A. Bouziane, R. Abouqal, Y. El Miedany, A. EL Maghraoui, and A. A. Kalla. "AB1031 PREVALENCE OF GLUCOCORTICOID INDUCED OSTEOPOROSIS IN AFRICAN ADULT PATIENTS WITH CHRONIC RHEUMATIC DISEASES. A SYSTEMATIC REVIEW AND META-ANALYSIS." Annals of the Rheumatic Diseases 81, Suppl 1 (May 23, 2022): 1639.1–1639. http://dx.doi.org/10.1136/annrheumdis-2022-eular.4288.

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BackgroundGlucocorticoid (GC) use is well established in the treatment of rheumatics diseases, particularly rheumatoid arthritis (RA). The use of low dose GC has been endorsed by EULAR recommendations for the management of rheumatic and musculoskeletal diseases even if in the context of SARS-CoV-2, but long-term use is generally discouraged.ObjectivesTo estimate the prevalence of glucocorticosteroids induced osteoporosis (GIOP) on bone mineral density (BMD) in African adult patients with inflammatory rheumatic diseases.MethodsFor this systematic review and meta-analysis, PubMed, Google Scholar, Scopus and African index medicus were systematically searched up to December 2020 without language restrictions. We included studies as follows: population-based or hospital-based study, study with sufficient information to estimate the prevalence of GIOP and osteoporotic fractures in African patients with rheumatic disease. Searches were limited to peer-reviewed full text articles. A standardized data extraction form was used to collect information from eligible studies. A random-effects meta-analysis was conducted to obtain the pooled prevalence of GIOP in these studies. The meta-analysis was stratified by geographical region. The study is registered with PROSPERO, number CRD42021256252.ResultsOur search identified 8571 studies, of which 8 studies were included in the systematic review from only four African countries and 7 studies in the meta-analysis. The pooled prevalence of osteoporotic fractures in our study was 47.7% (95% CI 32.9–62.8) with 52.2% (95% CI 36.5-67.6) in North Africa and 15.4% (95% 1.9-45.4%) in South Africa (SA). There was no evidence of publication bias, although heterogeneity was high (p=0.018). There was no data from sub-Saharan Africa apart from the two studies from SA.ConclusionThe overall prevalence of GIOP in African adult patients with inflammatory rheumatic diseases was high at 47.7% (95% CI 32.9–62.8). Meta-analysis calculation revealed patient geographic origin as possible confounding factors of the proportion outcomes and further studies are required.References[1]Landewé RB, Machado PM, Kroon F, et al. EULAR provisional recommendations for the management of rheumatic and musculoskeletal diseases in the context of SARS-CoV-2Annals of the Rheumatic Diseases 2020;79:851-858.Disclosure of InterestsNone declared

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Kolpakov, Konstantin I., Maxim A. Korolev, and Yuliya B. Ubshaeva. "The Value of Trabecular Bone Score in Patients with Rheumatic Diseases." Annals of the Russian academy of medical sciences 76, no. 4 (October 22, 2021): 402–11. http://dx.doi.org/10.15690/vramn1542.

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Background.Trabecular bone score obtained by lumbar spine Dual-energy X-ray Absorptiometry is a novel and insufficiently explored instrument of accessing trabecular bone quality. One of its promising applications is early diagnostics of osteoporosis (OP) before fragility fractures appear. Meanwhile most of systemic inflammatory rheumatic diseases affect bone tissue either directly and indirectly by glucocorticoids consumption. Both factors potentiate OP development and can influence the trabecular bone score. Aimsto evaluate the possibilities of trabecular bone score using in rheumatology. Materials and Methods.Data analysis of domestic and foreign scientific publications. Results and Discussion.Authors of analyzed publications note stable association of low trabecular bone score with vertebral fractures, its correlation with local inflammatory markers in lumbar spine and ankylosing spondylitis structural progression. In most studies trabecular bone score do not have association with systemic inflammatory activity and treatment. Conclusion. Trabecular bone score is effective in OP diagnostics in rheumatic patients, evaluation of local inflammatory activity in the lumbar spine and structural progression of ankylosing spondylitis.

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So, Jacqueline, and Chi Chiu Mok. "Glucocorticoid-Induced Osteoporosis: The Potential Role of Romosozumab." Journal of Clinical Rheumatology and Immunology 20, no. 02 (December 2020): 71–79. http://dx.doi.org/10.1142/s2661341720300074.

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Glucocorticoid (GC)-induced osteoporosis (GIOP) is a major problem in patients with rheumatic diseases. The deleterious effect of GC on bone turnover is rapid and dose-dependent, with a predilection on the trabecular bone, resulting in vertebral fractures. Early recognition and prompt treatment of GIOP helps prevent bone loss and reduce fractures. There are pitfalls in current assessment tools for GIOP by dual-energy X-ray absorptiometry (DXA) and fracture risk assessment tool (FRAX) estimation formula. In this review, we evaluate different assessment methods for GIOP and summarize current therapies of GIOP, including the antiresorptive and anabolic agents. The potential role of newer anti-osteoporosis agent romosozumab, an anti-sclerostin monoclonal antibody, is also discussed.

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Di Marcello, Francesca, Giulia Di Donato, Debora Mariarita d’Angelo, Luciana Breda, and Francesco Chiarelli. "Bone Health in Children with Rheumatic Disorders: Focus on Molecular Mechanisms, Diagnosis, and Management." International Journal of Molecular Sciences 23, no. 10 (May 20, 2022): 5725. http://dx.doi.org/10.3390/ijms23105725.

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Bone is an extremely dynamic and adaptive tissue, whose metabolism and homeostasis is influenced by many different hormonal, mechanical, nutritional, immunological and pharmacological stimuli. Genetic factors significantly affect bone health, through their influence on bone cells function, cartilage quality, calcium and vitamin D homeostasis, sex hormone metabolism and pubertal timing. In addition, optimal nutrition and physical activity contribute to bone mass acquisition in the growing age. All these factors influence the attainment of peak bone mass, a critical determinant of bone health and fracture risk in adulthood. Secondary osteoporosis is an important issue of clinical care in children with acute and chronic diseases. Systemic autoimmune disorders, like juvenile idiopathic arthritis, can affect the skeletal system, causing reduced bone mineral density and high risk of fragility fractures during childhood. In these patients, multiple factors contribute to reduce bone strength, including systemic inflammation with elevated cytokines, reduced physical activity, malabsorption and nutritional deficiency, inadequate daily calcium and vitamin D intake, use of glucocorticoids, poor growth and pubertal delay. In juvenile arthritis, osteoporosis is more prominent at the femoral neck and radius compared to the lumbar spine. Nevertheless, vertebral fractures are an important, often asymptomatic manifestation, especially in glucocorticoid-treated patients. A standardized diagnostic approach to the musculoskeletal system, including prophylaxis, therapy and follow up, is therefore mandatory in at risk children. Here we discuss the molecular mechanisms involved in skeletal homeostasis and the influence of inflammation and chronic disease on bone metabolism.

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Khramov, A. E., M. A. Makarov, S. A. Makarov, V. N. Amirdzhanova, A. V. Rybnikov, V. P. Pavlov, and A. A. Askerov. "Intraoperative periprosthetic fractures during total hip arthroplasty in patients with rheumatic diseases." Rheumatology Science and Practice 56, no. 6 (January 22, 2019): 791–96. http://dx.doi.org/10.14412/1995-4484-2018-791-796.

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Surgical treatment in patients with rheumatic diseases (RDs) is associated with the higher risk of complications due to the presence of the inflammatory process, to long-term therapy with glucocorticoids, disease-modifying antirheumatic drugs, and biologic agents (BA), to decreased physical activity, and the severity of functional disorders, and to obvious osteoporosis. All this increases the risk of intraoperative complications, including periprosthetic fractures.Objective: to comparatively analyze intraoperative periprosthetic fractures of the greater trochanter, acetabulum, and proximal femur during total hip arthroplasty (THA) in patients with RDs.Subjects and methods. From 1998 till 2017, a total of 1569 THA were performed in patients with RA, including 464 patients with rheumatoid arthritis (RA), 396 with juvenile rheumatoid arthritis (JRA) and systemic lupus erythematosus (SLE), and 709 with osteoarthritis (OA).Results and discussion. Periprosthetic fractures after THA were diagnosed in a total of 68 (4.33%) patients, including 23 (4.96%) patients with RA, 27 (6.82%) with JRA and SLE, and 18 (2.54%) with OA; 42 (61.8%) patients with periprosthetic fractures underwent osteosynthesis. Statistical analysis of the findings revealed significantly higher rates of complications in patients with RA and JRA with SLE (p < 0.005).Conclusion. The findings confirm that the risk of periprosthetic fractures is higher in patients with inflammatory diseases, including RA, JRA, and SLE. These patients require a special approach that involves medical correction of impaired bone metabolism and proper individual selection of endoprosthetic components, by taking into account the anatomical features of female patients and delicate bone handling during surgery.

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Toroptsova, N., O. Dobrovolskaya, O. Nikitinskaya, N. Demin, A. Smirnov, and L. Shornikova. "AB0915 BONE MINERAL DENSITY AND FRACTURE FREQUENCY IN PREMENOPAUSAL WOMEN WITH RHEUMATIC DISEASES." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1759.2–1759. http://dx.doi.org/10.1136/annrheumdis-2020-eular.2740.

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Background:The onset of the disease in young and middle age is typical for rheumatic diseases (RDS), but most studies on osteoporosis were conducted in patients (pts) older than 50 years, which included postmenopausal women.Objectives:To assess bone mineral density (BMD), fracture frequency and the factors associated with low BMD in premenopausal women with RDs.Methods:160 women (median age, 36 [29; 43] years): 120 pts with RDs (43 rheumatoid arthritis (RA), 53 systemic sclerosis (SSc) and 24 psoriatic arthritis (PsA)) and 40 age-matched healthy controls were enrolled in the study. We performed a dual-energy X-ray absorptiometry (DXA, Hologic Discovery A, USA) to measure BMD in lumbar spine, femoral neck and total hip. BMD decreasing grade was evaluated by the Z-score <-2SD. All pts were interviewed using a unified questionnaire including assessment of daily dietary calcium intake. Serum vitamin D, C-reactive protein and erythrocyte sedimentation rate (ESR) measurements were done.Results:25% pts with RDs and only 8% healthy controls have low BMD (p=0.02). RA, SSc and PsA pts had low BMD in 37%, 21% and 13%, respectively, that was more often than in healthy women (p=0.004, p=0.046 and p= 0.081, respectively). 9,3% RA pts and 7,5% SSc pts had low energy fractures. BMD of RDs pts in all areas of measurement demonstrated a direct correlation with height, weight, body mass index, and serum vitamin D concentration and an inverse correlation with the cumulative dose of glucocorticoids. Also, proximal femur BMD inversely correlated with RDs duration. BMD of femoral neck and total hip inversely correlated with C-reactive protein level in SSc pts. In RA women we found a direct correlation between lumbar spine and femur neck BMD and ESR.Conclusion:25% of premenopausal women with RDs had reduced BMD and needed monitoring and osteoporosis prevention, while 9.3% pts with RA and 7.5% women with SSc needed anti-osteoporotic treatment.Disclosure of Interests:None declared

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Mok, C. C., L. Y. Ho, S. M. Tse, and K. L. Chan. "POS0171 UNDERESTIMATION OF THE FRACTURE RISK BY THE FRAX FORMULA IN CHRONIC GLUCOCORTICOID USERS: A 10-YEAR LONGITUDINAL VALIDATION STUDY." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 298.2–298. http://dx.doi.org/10.1136/annrheumdis-2021-eular.3400.

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Background:Objectives:To compare the actual fracture incidence over 10 years in a longitudinal cohort of patients using glucocorticoids (GCs) with the risk prediction from FRAX (fracture risk assessment tool).Methods:Patients who attended our out-patient rheumatology clinics were included according to the following criteria: (1) adult patients ≥18 years; (2) underlying rheumatic diseases requiring prednisolone treatment (≥5mg/day); and (3) have had a DXA scan (baseline) performed between years 2007-2009. The predicted rates of major osteoporotic and hip fractures were estimated using FRAX (China database) based on the clinical data at the time of DXA, with adjustment when daily dose of prednisolone ≥7.5mg (multiply by 1.15 for major osteoporotic and 1.20 for hip fracture). The actual observed incidence of symptomatic vertebral and non-vertebral fractures at 10 years (in years 2017-2019) follow-up was retrieved by medical record review and compared with the estimated rates by FRAX. Factors associated with symptomatic clinical fractures at 10 years were studied by logistic regression.Results:89 patients were studied (age 49.3±8.8 years at DXA examination; 98% women). The underlying rheumatic diseases were systemic lupus erythematosus (69%), rheumatoid arthritis (17%) and others (14%). The mean daily dose of prednisolone at baseline was 7.7±6.5mg (38% patients had daily dose ≥7.5mg). History of personal fracture was present in 4(4.5%) patients and 22% of female patients had menopause before the age of 45 years. The mean body mass index (BMI) was 23.5±3.3kg/m2 (4.5% ≤18kg/m2). Osteoporosis (bone mineral density [BMD] T score ≤-2.5) of the hip, femoral neck and lumbar spine occurred at a frequency of 11.2%, 13.5% and 25.8%, respectively at baseline (32% at any of the 3 sites). 30(34%) patients received anti-osteoporotic treatment (oral bisphosphonates in 25, raloxifene in 3 and denosumab in 2 patients). The estimated mean 10-year risk of major osteoporotic and hip fractures using the BMD data and other risk factors in the FRAX formula, adjusted for prednisolone dose, was 4.3% and 1.0%, respectively. After a follow-up of 10 years, one patient had a hip fracture, 3 patients had humerus fractures and 9 patients had symptomatic vertebral fractures. The actual observed major osteoporotic and hip fracture incidence was 14.6% and 1.1%, respectively (0.146 and 0.011 per 10 patient-years). The observed major clinical fracture rate was significantly higher than that estimated by FRAX (14.6% vs 4.3%; p=0.04). Logistic regression revealed that the only factor independently associated with major clinical fracture at 10 years was BMD T score ≤-2.5 at spine, hip or femoral neck at baseline (OR7.11[1.73-29.2]; p=0.007). Age, prednisolone daily dose, BMI, history of fracture, chronic smoking, having underlying SLE vs not and early menopause were not significantly associated with new clinical fractures.Conclusion:Despite adjustment for prednisolone dosage, the FRAX formula underestimates the major clinical fracture risk in patients using long-term GCs. The deleterious effect of GCs on bone quality, high proportion of SLE patients, disease activity and use of additional doses of GCs and other immunosuppressive drugs during follow-up are among the contributing factors for this underestimation.Disclosure of Interests:None declared

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Wiebe, E., D. Freier, D. Huscher, R. Biesen, S. Hermann, and F. Buttgereit. "SAT0450 GLUCOCORTICOID-INDUCED OSTEOPOROSIS IN PATIENTS WITH CHRONIC INFLAMMATORY RHEUMATIC DISEASES: A MULTIVARIATE LINEAR REGRESSION ANALYSIS IDENTIFYING PREDICTIVE FACTORS FOR LOW BONE MASS." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1182.2–1182. http://dx.doi.org/10.1136/annrheumdis-2020-eular.4427.

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Background:Rheumatic diseases are associated with increased systemic bone loss and fracture risk related to chronic inflammation, disease-specific, general and demographic risk factors as well as treatment with glucocorticoids (GC). Yet, there is evidence that GCs may, by adequately suppressing systemic inflammation, also have a positive effect on bone mineral density (BMD) and fracture risk1.Objectives:The purpose of this study was to investigate the prevalence of osteoporosis and fragility fractures in patients with inflammatory rheumatic diseases and to analyze the impact that treatment with GCs, other known risk factors and preventive measures have on bone health in these patients.Methods:Rh-GIOP is an ongoing prospective observational study collecting and analyzing disease- and bone-related data from patients with chronic inflammatory rheumatic diseases and psoriasis treated with GCs. In this cross-sectional analysis, we evaluated the initial visit of 1091 patients. A multivariate linear regression model with known or potentially influential factors adjusted for age and sex was used to identify predictors of BMD as measured by dual-energy X-ray absorptiometry (DXA). Multiple imputation was applied for missing baseline covariate data.Results:In the total cohort of 1091 patients (75% female of which 87.5% were postmenopausal) with a mean age of 62.1 (±13.2) years, the prevalence of osteoporosis by DXA was 21.7%, while fragility fractures have occurred in 31.2% of the study population (6.7% vertebral, 27.7% non-vertebral). Current GC therapy was common (64.9%), with a median daily dose of 5.0mg [0.0;7.5], a mean life-time total GC dose of 17.7g (±24.6), and a mean GC therapy duration of 7.8 years (±8.5). Bisphosphonates were the most commonly used anti-osteoporotic drug (12.6%).Multivariate analysis showed that BMD as expressed by the minimum T-Score at all measured sites was negatively associated with higher age, female sex and menopause as well as Denosumab and Bisphosphonate treatment. A positive association with BMD was found for body mass index as well as current and life-time (cumulative) GC dose. While comedication with proton-pump-inhibitors significantly predicted low bone mass, concomitant use of non-steroidal anti-inflammatory drugs showed a positive association with BMD. Of the measured bone-specific laboratory parameters, higher alkaline phosphatase levels were determinants of low DXA-values, while the association was positive for gamma-glutamyltransferase.BMD was neither predicted by duration of GC treatment nor by treatment with disease modifying anti-rheumatic drugs.Predictive variables for BMD differed at the respective anatomical site. While treatment with Denosumab predicted low bone mass at the lumbar spine and not at the femoral neck, the opposite was true for health assessment questionnaire (HAQ) score. Current and life-time GC-dose as well as direct sun-exposure of more than 30 minutes daily were positively associated with bone mass at the femoral sites only.Conclusion:This cross-sectional analysis of a prospective cohort study quantified the prevalence of osteoporosis and identified predictive variables of BMD in patients with rheumatic diseases.Multivariate analyses corroborated low BMD to be predicted by traditional factors like age, female sex and menopause but showed current and well as life-time GC dose to be positively associated with BMD in our cohort of patients with chronic inflammatory rheumatic diseases. This suggests that optimal management of disease activity with GCs might be beneficial in order to avoid bone loss due to inflammation.References:[1]Güler-Yüksel et al. “Glucocorticoids, Inflammation and Bone.” Calcified Tissue International (January 08 2018).Disclosure of Interests:Edgar Wiebe: None declared, Desiree Freier: None declared, Dörte Huscher: None declared, Robert Biesen: None declared, Sandra Hermann: None declared, Frank Buttgereit Grant/research support from: Amgen, BMS, Celgene, Generic Assays, GSK, Hexal, Horizon, Lilly, medac, Mundipharma, Novartis, Pfizer, Roche, and Sanofi.

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Freier, D., E. Wiebe, R. Biesen, T. Buttgereit, S. Hermann, T. Gaber, and F. Buttgereit. "AB0767 PATIENTS WITH RHEUMATOID ARTHRITIS HAVE A LOWER BONE DENSITY THAN PATIENTS WITH PSORIATIC ARTHRITIS." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1681.1–1682. http://dx.doi.org/10.1136/annrheumdis-2020-eular.3447.

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Background:Osteoporosis is a skeletal disease characterized by the loss of bone density resulting in an increased fracture risk. Female sex, advanced age, Caucasian ancestry, previous history of fractures, menopause and certain genetic factors predispose for osteoporosis. In addition, recent studies could prove that chronic inflammatory diseases such as Rheumatoid Arthritis (RA) and long-term treatment with higher doses of glucocorticoids (GCs) represent independent risk factors for the development of osteoporosis. On the other hand, the intake of vitamin D, a calcium-rich diet and physical exercise can be protective. Data describing the prevalence of osteoporosis in patients with other rheumatic diseases like psoriatic arthritis (PsA) are lacking.Objectives:We compared the prevalence of osteopenia and osteoporosis in patients with RA and PsA, respectively, based on data obtained from our ongoing prospective monocentric study Rh-GIOP investigating glucocorticoid (GC)-induced osteoporosis in patients with different rheumatic diseases (NCT02719314).Methods:Bone mineral density data measured by dual x-ray absorptiometry (DXA) in patients with PsA (n=92) were compared with data measured in 92 age- and gender-matched patients with RA. The results were analysed with respect to clinical and laboratory parameters such as data on GC treatment (frequency, duration defined as start of treatment until timepoint of measurement, actual and cumulative dose), csDMARD and bDMARD (including as well tsDMARDs) therapy, serological parameters (Vitamin D, alkaline phosphatase, calcium, inflammatory markers and rheumatoid factor) and functional status (e.g. Health Assessment Questionnaire (HAQ), sporting activities). Statistical analyses were performed descriptively using mean and standard deviation, t-tests for metric variables, and chi-square tests for nominal variables. For subgroup analyses with less than 30 patients per group, tests for non-normally distributed data were used due to the lower test power.Results:RA patients showed significantly lower means of bone density values (minimal T-score, p=0.03) than PsA patients leading to a higher frequency of osteopenic bone densities (p<0.005). However, no differences in the frequency of osteoporotic bone densities could be detected. PsA patients reported a significantly longer disease duration and a higher current GC dosage. In contrast, the frequency of current GC intake was higher in RA patients. Although the calcium intake was higher in the RA group, neither blood levels of calcium and vitamin D, nor the cumulative GC dose (GCCD) or duration of GC therapy could indicate a causal relationship for the differences observed in bone density values between the two groups. The frequency of csDMARD therapy did not differ significantly between PsA and RA patients while the frequency of bDMARD therapy was higher in the PsA group (p=0.04).Conclusion:The lower bone density in RA patients seems not to be fully explained by higher GCCD, disease duration or higher levels of inflammation. However, RA patients had a higher frequency of current GC intake. Additionally, differences in bone density between the two groups could be related to the higher number of bDMARD therapies in PsA patients, but further investigations like multivariate analyses with higher numbers of patients are necessary. Furthermore there is more need for research on possible molecular and genetic factors in PsA, which are protecting from low bone density.Disclosure of Interests:Desiree Freier: None declared, Edgar Wiebe: None declared, Robert Biesen: None declared, Thomas Buttgereit: None declared, Sandra Hermann: None declared, Timo Gaber: None declared, Frank Buttgereit Grant/research support from: Amgen, BMS, Celgene, Generic Assays, GSK, Hexal, Horizon, Lilly, medac, Mundipharma, Novartis, Pfizer, Roche, and Sanofi.

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Rato, M., F. Pinheiro, S. Garcia, B. M. Fernandes, S. Ganhão, R. Gaio, M. Bernardes, A. Bernardo, and L. Costa. "SAT0482 FRAX 10-YR FRACTURE RISK IN RHEUMATOID ARTHRITIS ASSESSED WITH AND WITHOUT BONE MINERAL DENSITY – ARE WE TREATING OUR PATIENTS UNDER bDMARDs?" Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1197.1–1198. http://dx.doi.org/10.1136/annrheumdis-2020-eular.3354.

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Background:Patients with rheumatoid arthritis (RA) have a higher risk of osteoporosis not only due to chronic inflammation status, but also due to the treatment with glucocorticoids. FRAX is a computer-based algorithm developed by the World Health Organization for estimation of the 10-year risk of a hip or major osteoporotic fracture. Inclusion of femoral neck bone mineral density (BMD) in the estimation is optional.Objectives:The study aimed to identify the RA patients under treatment with biological disease-modifying antirheumatic drug (bDMARD), who have FRAX scores, calculated with and without BMD, classified as high fracture risk and evaluate if they are receiving treatment for osteoporosis. The authors also investigated the intra-individual agreement between FRAX fracture risk calculated with and without BMD.Methods:Demographic and clinical data and BMD results from RA patients followed in a tertiary university hospital and registered in the Rheumatic Diseases Portuguese Register were used for analysis. Patients under 40 years of age at the last visit were excluded. McNemar test was applied for the identification of discordance of risk categories. The Wilcoxon test was used to characterize the intraindividual differences between paired FRAX risks with and without BMD. Correlations between pairs of variables were evaluated by the Spearman test. For independent variables Mann-Whitney test was used.Results:A total of 303 patients were included, 244 were females (80.5%) and 49 current smokers (16.2%). Mean age was 59.5 ± 9.54 years and mean disease duration 18.5 ± 10.4 years. Two hundred and twenty patients (72.4%) and 243 (80.2%) were RF and ACPA positive, respectively, and 51.5% had erosive disease. Mean disease activity score (DAS28-4V-CRP) was 3.08 ± 1.18 and mean femoral neck BMD 0.84 ± 0.12 g/cm2. One hundred and seventy nine patients (58.9%) were concomitantly treated with conventional synthetic DMARDs and 215 (70.7%) with glucocorticoids. Among all the patients, 35 (11.6%) had previous fractures and 19 (6.3%) have family history of fracture. The median 10-year risk of a major fracture and a hip fracture, calculated without BMD, was 6.0 (1.2-50) and 1.5 (0.1-39), respectively; with BMD it was 6.9 (1.3-61) and 1.7 (0-49). When FRAX score is calculated without BMD (n=303), 76 (25.1%) patients were categorized as high fracture risk. Among them, only 41 (54%) were receiving osteoporosis treatment. FRAX assessment with BMD (n=231) identified 99 (32.7%) patients with high fracture risk, 51 (51,5%) in treatment for osteoporosis. Thirty patients (21%) previously classified as low fracture risk using FRAX without BMD were recategorized as high risk (p<0.001). Despite that, there was a strong correlation between fracture risks assessed with and without BMD for both major and hip fracture (r = 0.867, p < 0.0001 and r = 0.728, p < 0.0001, respectively). ACPA and RF positive patients did not have higher FRAX scores (including or not BMA). Patients with erosive disease had a higher 10-year probability of major fracture evaluated by FRAX when it includes BMD (p=0.041).Conclusion:It is very important to accurately assess the risk of osteoporotic fractures in RA patients to treat them properly. The authors highlight the high number of patients who are not receiving treatment according to FRAX categorization. In spite of the correlation between estimated fracture risk by FRAX with and without BMD, there is a discordance in fracture risk categorization, as one fifth of patients of low risk were reclassified as high risk. For the RA population treated with bDMARDS, our findings raise the need to request a DXA not only for patients classified as having an intermediate risk of fracture, but also for low-risk patients.Disclosure of Interests:Maria Rato: None declared, Filipe Pinheiro: None declared, Salomé Garcia: None declared, Bruno Miguel Fernandes: None declared, Sara Ganhão: None declared, Rita Gaio: None declared, Miguel Bernardes Speakers bureau: Abbvie, Amgen, Biogen, Eli-Lilly, Glaxo-Smith-Kline, Pfizer, Janssen, Novartis, Alexandra Bernardo: None declared, Lúcia Costa: None declared

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Kozhevnikova, P., I. Dydykina, P. Kovalenko, and A. Lila. "SAT0080 COMPARATIVE ANALYSIS OF FRAGILITY FRACTURE IN PATIENTS WITH ELDERLY ONSET RHEUMATOID ARTHRITIS AND YOUNG ONSET RHEUMATOID ARTHRITIS." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 974.1–975. http://dx.doi.org/10.1136/annrheumdis-2020-eular.1789.

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Background:Rheumatoid arthritis (RA) is a chronic autoimmune disease, characterized by erosive arthritis and systemic organ involvement. Chronic inflammation, long RA disease duration, decreased physical activity, immobilization, glucocorticoids use lead to local (periarticular osteoporosis) and generalized loss of bone tissue, decrease in bone mineral density, contravention of microarchitectonics and increased risk of fragility (low-energy) fractures. The structure and density of bone tissue at elderly onset RA, in addition to the above factors, are affected by comorbid diseases, sex steroids level decrease and molecular changes in bone tissue, specifically attributed to aging, followed by increased bone resorption. Fractures reduce the quality of life, have a negative impact on the course of the underlying and concomitant diseases.Objectives:Сompare frequency of fragility fracture in patients with elderly onset rheumatoid arthritis and young onset rheumatoid arthritis.Methods:We included 474 patients with RA diagnosed at 25– 78 years old and fulfilled the American College of Rheumatology (formerly American Rheumatism Association) classification criteria for RA revised in 1987. The patients were divided into two groups depending on age at the RA-onset: The first group (group I) included 217 patients with young onset RA (at 25 to 44 years), second group (group II) included 66 patients with elderly onset RA (aged ≥60 years). The distribution of patients into groups was consistent with the age classification of the World Health Organization. In total, it was selected 283 RA patients. The mean age in group I was 50.4 years, in group II - 71.2 years. The mean age at the onset of RA in group I was 35.0 years, in group II - 66.2 years.; RA duration was 14.4 years and 4.6 years, respectively. Long-term history of glucocorticoids use (for more than 3 months) was observed in 50% of patients in group I, and in 42% of patients in group II.Results:40 (18%) patients in group I and 17 (26%) patients in group II had fragility fractures. Among patients with fragility fracture, 23 (57,5%) patients in group I and 6 (35%) patients in group II received glucocorticoid therapy for more than 3 months. Two or more fractures in history had 16 (40%) in group I, and 3 (18%) in group II.Conclusion:The frequency of fragility fracture in the study groups was comparable (p> 0.05), despite the age of patients. But, the frequency of refractures was higher in patients with RA-onset at young age, which, apparently, is a consequence of long RA disease duration and use of glucocorticoids.Disclosure of Interests:None declared

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Wiebe, E., D. Freier, D. Huscher, G. Dallagiacoma, R. Biesen, S. Hermann, G. R. Burmester, and F. Buttgereit. "OP0300 A CROSS-SECTIONAL, MATCHED-PAIR ANALYSIS OF ACPA POSITIVE AND ACPA NEGATIVE RHEUMATOID ARTHRITIS PATIENTS COMPARING THE PREVALENCE OF OSTEOPOROSIS, FRAGILITY FRACTURES AND UNDERLYING RISK FACTORS." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 186.1–187. http://dx.doi.org/10.1136/annrheumdis-2020-eular.4391.

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Background:Rheumatoid arthritis (RA) is associated with increased systemic bone loss, leading to a high risk for fragility fractures. Especially anti-citrullinated protein antibody (ACPA) positivity is considered a risk factor for local bone erosions and systemic bone loss1.Objectives:The purpose of this study was to compare ACPA positive versus ACPA negative RA patients in terms of the prevalence of osteoporosis and fragility fractures and to identify differences in underlying risk factors that influence bone health.Methods:Rh-GIOP is an ongoing prospective observational study collecting and analyzing disease- and bone-related data from patients with chronic rheumatic diseases or psoriasis treated with glucocorticoids (GC). In this cross-sectional analysis, we performed a matched-pair analysis, matching 114 ACPA positive to 114 ACPA negative RA patients according to age (5-year-steps), sex, and body mass index (BMI, 2-unit-steps). Descriptive analyses were performed, with values displayed as mean ± standard deviation for continuous variables. Non-parametric tests were used at a two-sided significance level of 5% to compare differences in underlying and potential risk factors without adjustment for multiple testing.Results:At same mean age (63.9 ±10.2 years) and BMI (27.9 ±5.6kg/m2), the matched groups had a female proportion of 82.5%. APCA positive patients had a significantly longer mean disease duration (13.9 vs 9.9 years, p<0.001), a higher mean cumulative GC-dose (22.3 vs 13.2g, p<0.01) and mean duration of GC therapy (10.1 vs 6.6 years, p<0.01). There was no significant difference in the prevalence of osteoporosis as defined by dual-energy X-ray absorptiometry (DXA) (18.4 vs 20.2%), nor in the prevalence of vertebral (7.0 vs 5.3%) or non-vertebral fractures (31.6 vs 29.8%). C-reactive protein levels as a marker of disease activity were significantly higher in ACPA positive patients (mean: 8.8 vs 4.3mg/l, p= 0.02), while mean disease activity score (DAS)28 levels were slightly lower in ACPA positive patients (2.4 vs 2.7, p= 0.05). No difference in health assessment questionnaire (HAQ) score was found. RA-specific treatments were similar, especially concerning current mean daily GC-dose (6.7 vs 4.9mg/day), except for Rituximab and targeted synthetic disease modifying anti-rheumatic drugs (DMARDs) which were more commonly used in ACPA positive patients (9.6 vs 2.6%, p=0.05) and (5.3 vs 0%, p=0.029), respectively. ACPA positive patients did not differ significantly from ACPA negative patients in specific anti-osteoporotic treatment, nor in the prevalence of comorbidities or concomitant medication. There were no significant differences in bone-specific laboratory parameters.Conclusion:In a cross-sectional analysis of our cohort, the prevalence of osteoporosis and fragility fractures was similar between ACPA positive and ACPA negative RA patients, despite longer disease duration and GC-treatment in ACPA positive patients. This is remarkable since it implies that ACPA negative patients are at a similar risk for osteoporosis and associated fractures. Optimal management of disease activity with or without GCs may represent a mainstay in preventing disease-related comorbidities such as osteoporosis.References:[1]Steffen, U., Schett, G., & Bozec, A. (2019). How Autoantibodies Regulate Osteoclast Induced Bone Loss in Rheumatoid Arthritis. Frontiers in immunology, 10, 1483. doi:10.3389/fimmu.2019.01483Disclosure of Interests:Edgar Wiebe: None declared, Desiree Freier: None declared, Dörte Huscher: None declared, gloria dallagiacoma: None declared, Robert Biesen: None declared, Sandra Hermann: None declared, Gerd Rüdiger Burmester Consultant of: AbbVie Inc, Eli Lilly, Gilead, Janssen, Merck, Roche, Pfizer, and UCB Pharma, Speakers bureau: AbbVie Inc, Eli Lilly, Gilead, Janssen, Merck, Roche, Pfizer, and UCB Pharma, Frank Buttgereit Grant/research support from: Amgen, BMS, Celgene, Generic Assays, GSK, Hexal, Horizon, Lilly, medac, Mundipharma, Novartis, Pfizer, Roche, and Sanofi.

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Delvino, P., S. Monti, G. P. Grieco, E. Bozzalla Cassione, G. Franchi, L. Bogliolo, and C. Montecucco. "AB0617 High prevalence of osteoporosis and fragility fractures in patients with ANCA-associated vasculitis: a cross-sectional study." Annals of the Rheumatic Diseases 81, Suppl 1 (May 23, 2022): 1434.2–1435. http://dx.doi.org/10.1136/annrheumdis-2022-eular.1360.

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BackgroundThe advent of effective immunosuppressive treatments significantly improved the prognosis of ANCA-associated vasculitides (AAV), which have become chronic relapsing diseases. Patients with inflammatory rheumatic disorders are particularly prone to reduced bone mineral density (BMD) and fragility fractures (FF), due to chronic glucocorticoid therapy, immunosuppressant-induced hypogonadism, systemic inflammation, functional disability and comorbidities. At present, there is paucity of data concerning the risk of osteoporosis and FF in AAV.ObjectivesTo describe the occurrence of osteoporosis and major FF in a cross-sectional cohort of patients with AAV.MethodsPatients diagnosed with granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA), according to ACR criteria and/or Chapel Hill definitions and regularly followed-up in our vasculitis center were included. BMD was measured by dual-energy X-ray absorptiometry (DEXA) of the proximal femur and lumbar spine, between March 2016 and September 2021. Osteoporosis was defined by a T-score below –2.5 SD, whereas osteopenia was defined by a T-score between -1 and -2.5 SD, according to the World Health Organization criteria. Vertebral fractures were assessed by X-ray of the dorso-lumbar spine. Data on previous osteoporotic hip fractures were collected.ResultsSixty-two consecutive patients were included (59.7% female, mean age at time of DEXA 61.8±10.5 years, disease duration 97.0±76.1 months). Sixteen (25.8%), 8 (12.9%) and 38 patients (61.3%) were affected by GPA, MPA and EGPA, respectively. BMD findings indicating osteoporosis and osteopenia, at either the lumbar spine and/or the proximal femur, were observed in 15 (24.2%) and 39 patients (62.9%), respectively, whilst only 8 patients (12.9%) had normal BMD values at both sites. Fifteen patients (24.2%) reported 51 major FF (50 vertebral fractures, 1 hip fracture) during follow-up, with multiple major FF being recorded in 10 patients (16.1%). Osteoporosis, at least at one site, was frequent not only in post-menopausal women (19.4%), but also in 6 males (24%), 3 pre-menopausal women (50%) and 3 patients under 50 years of age (37.5%), respectively (Figure 1). Similarly, major FF occurred in 4 males (16.7%), 1 pre-menopausal female (16.7%) and 1 patient under 50 years of age (12.5%), respectively (Figure 1). Patients with osteoporosis presented a lower body mass index (BMI) (23.1±4.1 vs 25.9±4.4, P=0.03) and a higher prevalence of major FF (53.3% vs 14.9%, P=0.003) compared to patients without osteoporosis. Compared to patients without major FF, those affected by major FF were older (68.8±1.8 vs 59.4±9.3 years, P=0.003), had a higher disease duration (146.9±78.8 vs 81.8±68.9 months, P=0.003) and presented with lower proximal femur BMD values (0.657±0.122 vs 0.761±0.127 g/cm2, P=0.007) and proximal femur T-score (-2.0±0.9 vs -1.4±0.8 SD). Notably, 7 out 15 patients with FF (46.7%) did not exhibit BMD findings of osteoporosis. Other variables, including sex, disease subtype, ANCA status, chronic kidney disease or treatment with cyclophosphamide were not related to bone loss or FF.Figure 1.Proportion of patients with osteopenia, osteoporosis and major fragility fractures stratified according to sex, menopausal status and age.ConclusionPatients with AAV are particularly susceptible to BMD loss and fractures, with osteoporosis and major FF being reported in about a quarter of patients. Short-term and long-term monitoring for reduced BMD and FF is warranted in all patients with AAV, including male patients, premenopausal females and those under 50 years of age.Disclosure of InterestsNone declared

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Rossini, M., N. Malavolta, G. La Montagna, S. Maddali Bongi, O. Di Munno, A. Del Puente, G. Minisola, et al. "THU0412 Prevalence and Incidence of Osteoporotic Fractures in Patients on Long-Term Glucocorticoid Treatment for Rheumatic Diseases: The Glucocorticoid Induced Osteoporosis Tool, Giotto Study." Annals of the Rheumatic Diseases 72, Suppl 3 (June 2013): A304.2—A304. http://dx.doi.org/10.1136/annrheumdis-2013-eular.940.

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Ng, K. L., M. Mohd Zain, and I. S. Lau. "POS1114 INFECTION RISK AMONG RHEUMATIC PATIENTS RECEIVING DENOSUMAB THERAPY: SINGLE CENTRE EXPERIENCE." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 837.1–837. http://dx.doi.org/10.1136/annrheumdis-2021-eular.3038.

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Background:Osteoporosis (OS) is common in rheumatic diseasas (RMD). OS fracture leads to morbidity and premature mortality. The treatment for OS is well established with good long term safety profile. Oral bisphosphonate (BIS) is recommended as initial treatment option for both postmenopausal and glucocorticoid induced OS. Denosumab (DSB), is the noninferior alternative option. Despite its efficacy, DSB was linked with elevated infection risk in non RMD. Yet, data in RMD is lacking.Objectives:To determine the infection risk and associated factors in RMD patients receiving DSB.Methods:This is retrospective cohort study. Data was extracted from medical database (between Jan 2010 & Dec 2018) at Selayang Hospital, Malaysia. Descriptive statistical analysis, logistic regression (LR) and cox (proportional hazard) regression [CPHR] were the analysis methods.Results:50 cases were analysed. 96% were female. The median age was 72.5 ± 12.7 years. The primary rheumatological disorders were rheumatoid arthritis (48%), OS (24%) and systemic lupus erythematosus (10%). 92% had ≥ 1 comorbidity including metabolic/cardiovascular diseases (74%), chronic lung diseases (CLD) (40%) and diabetes mellitus (DM) (22%). 54% had disease modifying anti rheumatic drug (DMARD) therapy; majority (59.2%) received single conventional synthetic DMARD. Only 7.4% received combination biologic DMARD therapy. 28% had received prednisolone therapy, with dose < 7.5mg OD in 78.6%.The median age at DSB initiation was 71 ± 12.4 years. 38% had fracture history and 88% had received previous OS treatment.In total, 13 infection episodes were recorded. The infection risk was 26% & incidence rate was 134 cases per 1000 person-years. 84.6% required hospitalisation and 38.5% were severe cases. The mortality rate was 23.1%. The mean DSB treatment duration to first infection was 15.46 ± 11.9 months.Univariate LR showed infection risk and hospitalisation were higher with longer DSB treatment duration, OR 1.062 (95% CI: 1.010 - 1.117), p = 0.018) & OR 1.057 (95% CI: 1.003 - 1.114, p = 0.037), respectively. These risks were lower in absence of steroid use, OR 0.2 (95% CI: 0.051 - 0.784, p = 0.021) and OR 0.215 (95% CI: 0.052 - 0.889, p = 0.034), respectively. Additionally, infection risk was lower in absence of CLD, OR 0.188 (95% CI: 0.048 - 0.742, p = 0.017) and hospitalisation was lower without concomitant DM, OR 0.050 (95% CI: 0.050 — 0.950, p = 0.043). Yet, multivariate LR did not infer the above predictions, after adjustment made for age, gender, rheumatological diseases, comorbidity, DMARD therapy and steroid dosing. For severe infection and case fatality, no predictive factors were identified.CPHR showed patients without steroid use had lower fatality risk, HR 0.077 (95% CI: 0.007 - 0.864, p = 0.038). With confounding factors (age, gender, previous infection and comorbidity), the observed difference was insignificant.Conclusion:Risk of infection and hospitalisation could be higher in rheumatic patients receiving longer DSB treatment duration. Concomitant comorbidities (CLD and DM) might increase the risk of infection and/or hospitalisation.References:[1]Cummings SR, San Martin J, McClung MR, Siris ES, Eastell R, Reid IR, et al. Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med 2009;361:756–65.[2]Watts NB, Roux C, Modlin JF, Brown JP, Daniels A, Jackson S, Smith S, Zack DJ, Zhou L, Grauer A, Ferrari S. Infections in postmenopausal women with osteoporosis treated with denosumab or placebo: coincidence or causal association? Osteoporos Int. 2012;23(1):327–337.[3]Prabhakaran S, Pritchard C. Comparison of infection rates in patients receiving denosumab, denosumab and biologics and biologics alone in a suburban rheumatology clinic [abstract]. Arthritis Rheumatol 2014;66 Suppl 10:S409.[4]Bray V, Bagley A, West S, Etzel C, Kremer J, Kolfenbach J. Infection risk among patients receiving concurrent denosumab and biologic or non-biologic DMARD therapy: An analysis of the ConsortiumAcknowledgements:We would like to thank the Director General of Health Malaysia for his permission for this poster presentation.Disclosure of Interests:None declared.

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Figueroa-Parra, G., E. Barriga-Maldonado, C. A. Cavazos-Cavazos, C. M. Gamboa-Alonso, A. L. De-Leon-Ibarra, D. Á. Galarza-Delgado, and C. M. Skinner Taylor. "SAT0466 FRAX RISK OF FRACTURE AND ITS CORRELATION WITH BONE MINERAL DENSITY IN MEXICAN PATIENTS WITH RHEUMATIC DISEASES." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1190–91. http://dx.doi.org/10.1136/annrheumdis-2020-eular.5060.

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Background:Osteoporosis (OP) is characterized by compromised bone strength and deterioration of quality, often leading to fragility fractures (1). Dual-energy x-ray absorptiometry (DXA) is the recommended test for OP screening among patients with rheumatoid arthritis (RA) and other RD (2). However, there are limitations to perform DXA on every patient, and the clinicians use screening tools to identify those patients with higher risk. The opportune identification of the patients at increased risk and early treatment can prevent the loss of bone mineral density (BMD) and reduce the risk of fractures(3).Objectives:To evaluate the FRAX risk and its correlation with the spine and femoral neck T-score in patients with RD.Methods:An observational retrospective study was done in the rheumatology clinic of the university hospital “Dr. Jose Eleuterio Gonzalez” in Monterrey, Mexico, between March and November 2019. Patients who had reported DXA from the spine and hip in the medical record were included. The risk factors included in FRAX tool was collected; FRAX tool was used online athttps://www.sheffield.ac.uk/FRAX/(algorithm for Mexicans) and classified as low (<10% for OP or <1% for hip), intermediate (10%-19% for OP or 1%-<3% for hip) and high risk (≥20% for OP or ≥3% for hip); results of DXA of the spine and hip were collected. Results are shown in means or frequency. A chi-square test or one-way analysis of variance was used to compare groups. Pearson’s correlation test (r) was done between spine T-score and FRAX risk for OP and between femoral neck T-score and FRAX risk for hip. P<0.05 was considered statistically significant.Results:141 patients were included, Patients with OP was older (mean 62.6 years), weight and height were higher in those with normal BMD. There was no difference between the use of glucocorticoids or other risk factors (Table 1). According to FRAX risk for OP, 122 (86.5%) had low risk, 14 (9.9%) had intermediate risk and only 5 (3.5%) had high risk. According to FRAX risk for hip, 81 (57.4%) had low risk, 38 (27.0%) had intermediate risk and only 22 (15.6%) had high risk (Table 2). There was a low negative correlation between spine T-score and FRAX risk for OP (r= -0.396, P=<0.001) (Figure 1), there was a moderate negative correlation between femoral neck T-score and FRAX risk for hip (r= -0.614, P=<0.001) (Figure 2).Table 1.FRAX score risk factorsNormal BMDN= 27Low BMDN= 66OsteoporosisN= 48PAge, years, mean (SD)46.8 (10.6)56.5 (11.7)62.6 (9.1)<0.001*Female, n (%)24 (88.8%)61 (92.4)43 (89.5)0.814Weight, kg, mean (SD)76.6 (14.6)66.4 (12.1)64.8 (10.6)0.001*Height, cm, mean (SD)156.7 (7.5)152.3 (6.8)153.3 (7.1)0.034*Previous Fracture, n (%)----Parent Fractured Hip, n (%)----Current Smoking, n (%)-2 (3.0%)4 (8.3%)0.060Glucocorticoids, n (%),15 (55.5%)30 (45.4%)19 (39.6%)0.411Rheumatoid arthritis, n (%)18 (66.6%)40 (60.6%)21 (43.7%)0.040*Secondary osteoporosis, n (%)----Alcohol use, n (%)1 (3.7%)2 (3.0%)1 (2.0%)0.631Osteoporosis treatment, n (%)-16 (24.2%)42 (87.5%)<0.001*Table 2.BMD and FRAX riskNormal BMDN= 27Low BMDN= 66OsteoporosisN= 48PFRAX risk for OP, n (%)Low risk, (n=122)27 (100%)63 (95.4%)32 (66.6%)<0.001*Intermediate risk, (n=14)-3 (4.5%)11 (22.9%)0.001*High risk, (n=5)--5 (10.4%)0.007*FRAX risk for hip, n(%)Low risk, (n=81)26 (96.3%)45 (68.1%)10 (20.8%)<0.001*Intermediate risk, (n=38)1 (3.7%)18 (25.7%)20 (41.6%)0.001*High risk, (n=22)-4 (6.0%)18 (37.5%)<0.001*Conclusion:Most of the patients were classified as low risk for OP and hip, including a high amount of those with OP showing a low and moderate correlation with DXA respectively.References:[1]Ann Intern Med. 2017;166(11):818-839[2]Osteoporos Int. 2014; 25(10): 2359-81[3]Arthritis Rheumatol. 2019;71(Suppl 10):3924-3925Disclosure of Interests:None declared

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Figueroa-Parra, G., A. Y. Lujano Negrete, R. Moyeda Martinez, C. M. Gamboa-Alonso, D. Á. Galarza-Delgado, and C. M. Skinner Taylor. "AB0624 COMPARISON OF DIFFERENT FRAX SCORES WITHOUT BONE MINERAL DENSITY FOR THE EVALUATION OF RISK FRACTURE IN MEXICAN PATIENTS WITH RHEUMATIC DISEASES." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 1345.3–1346. http://dx.doi.org/10.1136/annrheumdis-2021-eular.4144.

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Background:Osteoporosis (OP) is characterized by compromised bone strength and deterioration of quality, often leading to fragility fractures(1). Dual-energy x-ray absorptiometry (DXA) is the recommended test for OP screening(1). However, there are limitations to perform DXA on all patients, and the clinicians use screening tools to identify those patients with higher risk, like the FRAX score(2). Nevertheless, these scores have showed low to moderate correlation with DXA in RD patients(3).Objectives:To evaluate the fracture risk in RD patients, using different versions of FRAX scores without a bone mineral density (BMD) measure.Methods:An observational prospective study was performed at the Rheumatology Clinic in the University Hospital “Dr. Jose Eleuterio Gonzalez” in Monterrey, Mexico, between August and October 2020. Consecutive patients with a RD were evaluated as part of a “Bone Health Program”(3). Demographics and the risk factors included in FRAX tool was collected from ≥40 years-old patients; FRAX score was calculated online at https://www.sheffield.ac.uk/FRAX/ (algorithm for Mexicans). Four versions were calculated: 1) FRAX score without (w/o) BMD; 2) FRAX score with a T-score of -1.0 (w/Op); 3) FRAX score with a T-score of -2.5 (w/OP) and a FRAX score with positive previous fracture (Fx+). Then were classified as low (<10% for OP or <1% for hip), intermediate (10%-19% for OP or 1%-<3% for hip) and high risk (≥20% for OP or ≥3% for hip). Results are shown in means (SD) or frequency (%). A chi-square test was used to compare groups. Spearman’s correlation test (rho) was done between OP risk and Hip risk in each version of FRAX. P<0.05 was considered statistically significant.Results:One hundred and three patients were included, 93.2% were woman. The most frequent diagnosis was RA in 51.5% of patients, followed by osteoarthritis in 7.8%. 62.1% of patients had a previous BMD measured by DXA. 21.4% had history of previous fracture. 61.2% of patients were taking glucocorticoids. (Table 1). According to FRAX risk w/o BMD, 82 (79.6%) had low risk, 13 (12.6%) had intermediate risk, and 8 (7.8%) had high risk for OP. According to FRAX risk w/o BMD, 59 (57.3%) had low risk, 24 (23.3%) had intermediate risk, and 20 (19.4%) had high risk for hip fracture (Table 2). The correlations between OP risk and Hip risk in each version were as follow: FRAX w/o BMD (rho= .734, P= <.001) FRAX w/Op (rho= .308, P= .002); FRAX w/OP (rho= .476, P= <.001); FRAX with Fx+ (rho= .634, P= <.001).Conclusion:There is a wide variability among the different FRAX risk scores evaluated, and moderate to high correlation between the OP and Hip risk in patients with RD.References:[1]Ann Intern Med. 2017;166(11):818-839. doi:10.7326/M15-1361[2]Arthritis Rheumatol. 2019;71(suppl 10):3924-3925[3]Ann Rheum Dis. 2020;79:1190-1191Table 1.FRAX score risk factorsN= 10395% C.I.Age, years, mean (SD)57.0 (9.56)55.1 – 58.9Female, n (%)96 (93.2)86.4 – 96.9Weight, kg, mean (SD)68.2 (14.88)65.3 – 71.2Height, cm, mean (SD)154.6 (6.73)153.3 – 155.9Previous Fracture, n (%)22 (21.4)14.5 – 30.3Parent Fractured Hip, n (%)12 (11.7)6.7 – 19.4Current Smoking, n (%)12 (11.7)6.7 – 19.4Glucocorticoids, n (%),63 (61.2)51.5 – 70.0Rheumatoid arthritis, n (%)53 (51.5)41.9 – 60.9Secondary osteoporosis, n (%)1 (1.0)0.0 – 5.8Alcohol use, n (%)1 (1.0)0.0 – 5.8Previous DXA, n (%)64 (62.1)52.5 – 70.9Disclosure of Interests:None declared.

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Koumakis, Eugénie, Jérôme Avouac, Renaud Winzenrieth, Emese Toth, Judith Payet, André Kahan, Yannick Allanore, and Catherine Cormier. "Trabecular Bone Score in Female Patients with Systemic Sclerosis: Comparison with Rheumatoid Arthritis and Influence of Glucocorticoid Exposure." Journal of Rheumatology 42, no. 2 (December 1, 2014): 228–35. http://dx.doi.org/10.3899/jrheum.140752.

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Objective.Systemic sclerosis (SSc) is associated with an increased risk of osteoporosis and fractures. To date, the etiology of bone loss in SSc is unclear. Trabecular bone score (TBS) provides an indirect measurement of bone microarchitecture, independent of areal bone mineral density (aBMD). The aims were to assess bone involvement in SSc using TBS in comparison with a “high-risk” population with rheumatoid arthritis (RA) and controls, and to investigate the determinants of a low TBS.Methods.This was a cross-sectional study of 65 women with SSc, 138 age-matched female patients with RA, and 227 age-matched female controls. Spine and hip aBMD were assessed using dual-energy X-ray absorptiometry. TBS was calculated from the anteroposterior image of the spine aBMD.Results.TBS was significantly lower in SSc compared to controls (p < 0.0001) and did not differ from RA (p = 0.128), despite lower cumulative and daily glucocorticoid (GC) dose (p < 0.0001). Further, patients with SSc receiving GC ≥ 5 mg/day had a significantly lower TBS than those receiving GC < 5 mg/day (p = 0.001). Multivariate analysis revealed that a low TBS was independently associated with daily GC dose (OR 5.6, 95% CI 1.7–19.2) and a T score ≤ −2.5 SD (OR 5.0, 95% CI 1.5–7.0) in SSc. No association between GC and TBS was found in RA.Conclusion.Our results support the development of a combined approach using both TBS and aBMD for the assessment of bone microarchitecture in inflammatory rheumatic diseases. Our study showed that SSc-related bone involvement is characterized by an impairment in bone quality in addition to reduced bone quantity, and highlights that TBS can identify the negative effect of GC on bone microarchitecture.

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Palmowski, A., E. Wiebe, B. Muche, S. Hermann, C. Dejaco, E. Matteson, and F. Buttgereit. "POS1139 GLUCOCORTICOIDS AND BONE DENSITY IN POLYMYALGIA RHEUMATICA, GIANT CELL ARTERITIS, AND OTHER VASCULITIDES – A CROSS-SECTIONAL ANALYSIS OF THE Rh-GIOP COHORT." Annals of the Rheumatic Diseases 81, Suppl 1 (May 23, 2022): 898.1–898. http://dx.doi.org/10.1136/annrheumdis-2022-eular.467.

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BackgroundThere are only few, inconclusive investigations on bone density and the effects of glucocorticoids (GCs) in polymyalgia rheumatica (PMR) and vasculitides.ObjectivesTo determine whether GCs are associated with bone density in patients with PMR and other vasculitides after adjustment for confounders.MethodsThe Rh-GIOP cohort study started in 2015 and investigates bone health in patients with rheumatic diseases. In this cross-sectional analysis of baseline visits, we included patients with PMR and vasculitides. Multiple regression was used to model the effect of current and cumulative GC intake on the minimum T-score (mTs; lumbar spine or hip) with adjustment for several confounders such as age, sex, body mass index (BMI), or inflammation (measured by c-reactive protein (CRP)). GCs were modelled both as continuous and as categorical predictors in separate models. Several sensitivity analyses were performed. Patients with early disease (<3 months) were excluded from inferential analyses as were patients with very high GC dosages (>100mg/d prednisolone equivalent). Multiple imputation by chained equations was used for missing data (about 5%).Results198 patients (mean age 68 ± 11 years; 68% females) with a mean disease duration of 5.3 ± 6.3 years were included. The most common rheumatic disease was PMR (36%), followed by giant cell arteritis (26%) and granulomatosis with polyangiitis (17%). 87% were currently taking GCs, 88% received vitamin D supplements, 7% had a deficiency. Osteoporosis (OP) diagnosed by DXA (T-score ≤ -2.5) was present in 20% of patients. Mean CRP was 13.2 ± 26.1 mg/l. Scatter- and boxplots of mTs and GC intake are presented in Figure 1 A-D. GC dose was not associated with mTs in any model (current intake: β(continuous model) = -0.01, 97.5% CI -0.02 to 0.01; p(all models) ≥ 0.49; cumulative intake: β(continuous model) = 0.01, 97.5% CI -0.04 to 0.07; p(all models) ≥ 0.35). Inflammation (measured by CRP) was also not associated with mTs (p(all models) ≥ 0.56), and no significant interaction between CRP and GC intake was found (p for interaction(all models) ≥ 0.32). Lower body mass index (p(all models) ≤ 0.01), history of vertebral fractures (p(all models) ≤ 0.02), and proton-pump inhibitor intake (p(all models) ≤ 0.04) were associated with bone loss in all models. The results were similar with femoral neck and lumbar spine T-scores as dependent variables, and after excluding patients with PMR.Figure 1.ConclusionIn this cohort of PMR and vasculitides, the prevalence of OP was similar to the overall elderly German population.1 Vitamin D supplementation was common while deficiencies were surprisingly rare – In population-based studies, about 32% of Germans are estimated to have a vitamin D deficit.2 We found no association between current or cumulative GC intake, inflammation, and bone density. Proton-pump inhibitor intake and BMI as modifiable risk factors were associated with mTs. These findings need confirmation from longitudinal analyses of our and other cohorts.References[1]Fuchs J, Scheidt-Nave C, Kuhnert R. 12-Monats-Prävalenz von Osteoporose in Deutschland: Robert Koch-Institut, Epidemiologie und Gesundheitsberichterstattung, 2017.[2]Rabenberg M, Mensink G. Vitamin-D-Status in Deutschland: Robert Koch-Institut, Epidemiologie und Gesundheitsberichterstattung, 2016.AcknowledgementsFunding Rh-GIOP is supported by a joint funding from Amgen, Biogen, BMS, Chugai, Generic Assays, GSK, Hexal, Horizon Therapeutics, Lilly, Medac, Mundipharma, Novartis, Pfizer, Roche and Sanofi.Disclosure of InterestsAndriko Palmowski: None declared, Edgar Wiebe Grant/research support from: Travel expenses and consultancy fees from Medac, Burkhard Muche Speakers bureau: Speaker fees of one of these: Amgen, Gilead, Galapagos, UCB and Stadapharm, Consultant of: Consultancy fees of one of these: Amgen, Gilead, Galapagos, UCB and Stadapharm, Grant/research support from: Conference expenses of one of these: Amgen, Gilead, Galapagos, UCB and Stadapharm, Sandra Hermann Speakers bureau: Lecture fees from AbbVie, Christian Dejaco Speakers bureau: Speaker fees from one of these: Abbvie, Eli Lilly, Janssen, Novartis, Pfizer, Roche, Galapagos and Sanofi, Consultant of: Consulting fees from one of these: Abbvie, Eli Lilly, Janssen, Novartis, Pfizer, Roche, Galapagos and Sanofi, Eric Matteson Speakers bureau: editorial and contributor, UpToDate, Consultant of: editorial and contributor, UpToDate, Employee of: editorial and contributor, UpToDate, Frank Buttgereit Speakers bureau: Abbvie, AstraZeneca, Grünenthal, Pfizer, and Roche, Consultant of: Abbvie, AstraZeneca, Grünenthal, Pfizer, and Roche, Grant/research support from: Travel expenses: Abbvie, AstraZeneca, Grünenthal, Pfizer, and Roche. Grant support: Abbvie, Pfizer and Roche

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Palmowski, Andriko, Edgar Wiebe, Burkhard Muche, Sandra Hermann, Christian Dejaco, Eric Matteson, and Frank Buttgereit. "Glucocorticoids Are Not Associated with Bone Mineral Density in Patients with Polymyalgia Rheumatica, Giant Cell Arteritis and Other Vasculitides—Cross-Sectional Baseline Analysis of the Prospective Rh-GIOP Cohort." Cells 11, no. 3 (February 4, 2022): 536. http://dx.doi.org/10.3390/cells11030536.

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Background: Glucocorticoids (GCs) can cause osteoporosis (OP). Prior observational research on bone density and the effects of GCs in polymyalgia rheumatica (PMR) and vasculitides is scarce and inconclusive. Methods: Rh-GIOP is a prospective cohort study of bone health in patients with inflammatory rheumatic diseases. In this cross-sectional baseline analysis, we focused on patients with PMR and different forms of vasculitides. Multivariable linear regression was used to model the effect of current and cumulative GC intake on the minimum T-score at any site (mTs; at either lumbar spine or hip), with comprehensive adjustment for confounders. In separate models, GCs were modelled both as continuous and categorical predictors. Sensitivity analyses, stratifying by measurement site and disease, were conducted. Results: A total of 198 patients, with a mean age of 67.7 ± 11.4 years and a mean disease duration of 5.3 ± 6.3 years, were included. Most patients suffered from PMR (36%), giant cell arteritis (26%) or granulomatosis with polyangiitis (17%). Women comprised 66.7% of the patients, and 87.4% were currently taking GCs. The mean CRP was 13.2 ± 26.1 mg/L. OP diagnosed by dual energy X-ray absorptiometry (DXA) (T-score ≤ −2.5) was present in 19.7% of the patients. While 88% were taking vitamin D supplements, calcium supplementation (4%) and treatment with anti-resorptive agents (17%) were relatively infrequent. Only 7% had a vitamin D deficit. Neither current (β(continuous model) = −0.01, 97.5% CI –0.02 to 0.01; p(all models) ≥ 0.49) nor cumulative (β(continuous model) = 0.01, 97.5% CI −0.04 to 0.07; p(all models) ≥ 0.35) GC doses were associated with mTs in any model. CRP was not associated with mTs in any model (p(all models) ≥ 0.56), and no interaction between CRP and GC intake was observed (p for interaction(all models) ≥ 0.32). Across all analyses, lower body mass index (p(all models) ≤ 0.01), history of vertebral fractures (p(all models) ≤ 0.02) and proton-pump inhibitor intake (p(all models) ≤ 0.04) were associated with bone loss. Sensitivity analyses with femoral neck and lumbar spine T-scores as dependent variables led to similar results as the analysis that excluded patients with PMR. Conclusions: In this cohort of PMR and vasculitides, we found a similar prevalence of OP by DXA to the overall elderly German population. Vitamin D supplementation was very common, and vitamin D insufficiency was less frequent than expected in Germans. There was no association between current or cumulative GC intake, CRP and impaired bone density. Proton-pump inhibitors seem to be a major, but somewhat neglected, risk factor for OP and should be given more attention. Our findings require confirmation from longitudinal analyses of the Rh-GIOP and other cohorts.

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Lai, E. L., W. N. Huang, H. H. Chen, C. Y. Hsu, D. Y. Chen, T. Y. Hsieh, W. T. Hung, et al. "Ten-year fracture risk by FRAX and osteoporotic fractures in patients with systemic autoimmune diseases." Lupus 28, no. 8 (June 9, 2019): 945–53. http://dx.doi.org/10.1177/0961203319855122.

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The Fracture Risk Assessment Tool (FRAX) has been used universally for the purpose of fracture risk assessment. However, the predictive capacity of FRAX for autoimmune diseases remains inconclusive. This study aimed to compare the applicability of FRAX for autoimmune disease patients. This retrospective study recruited rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and primary Sjögren syndrome (pSS) patients with bone mineral density (BMD) tests. Patients with any osteoporotic fractures were identified. Taiwan-specific FRAX with and without BMD were then calculated. In total, 802 patients (451 RA, 233 SLE and 118 pSS) were enrolled in this study. The cumulative incidences of osteoporotic fractures in the RA, SLE and pSS patients were 43.0%, 29.2% and 33.1%, respectively. For those with a previous osteoporotic fracture, T-scores were classified as low bone mass. Overall, the patients’ 10-year probability of major fracture risk by FRAX without BMD was 15.8%, which then increased to 20.3% after incorporation of BMD measurement. When analyzed by disease group, the fracture risk in RA patients was accurately predicted by FRAX. In contrast, current FRAX, either with or without BMD measurement, underestimated the fracture risk both in SLE and pSS patients, even after stratification by age and glucocorticoid treatment. For pSS patients with major osteoporotic fractures, FRAX risks imputed by RA were comparable to major osteoporotic fracture risks of RA patients. Current FRAX accurately predicted fracture probability in RA patients, but not in SLE and pSS patients. RA-imputed FRAX risk scores could be used as a temporary substitute for SLE and pSS patients.

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Adami, G., A. Fassio, A. Giollo, G. Orsolini, O. Viapiana, D. Gatti, and M. Rossini. "SAT0452 DIFFERENT PROFILE OF RISK OF FRACTURE IN PATIENTS TREATED WITH ANTI-OSTEOPOROTIC DRUGS IN ITALY USING A NEW ALGORITHM." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1183. http://dx.doi.org/10.1136/annrheumdis-2020-eular.2559.

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Background:A new algorithm for management of patients at low, high and very high risk of osteoporotic fractures has been recently proposed, has been also recommended treating those patients at very high risk of fracture with bone anabolics (1). A similar treatment algorithm has been applied in Italy since 2015, when the “Nota 79”, that regulates the reimbursability for osteoporosis medications, has been developed by the Italian Agency for Drugs (AIFA) (2).Objectives:In the present study, using a new mathematical and computerized algorithm, we seek to investigate the profile of risk of fracture of patients starting treatment with different anti-osteoporotic medications in Italy.Methods:We retrospectively analyzed the 10-year risk of major osteoporotic fracture calculated with the DeFRAcalc79 tool in postmenopausal women aged over 50 years that were initiating an anti-osteoporotic treatment (fully reimbursed according to the Nota 79). DeFRAcalc79 is a new web-based fracture risk-assessment tool (https://defra-osteoporosi.it) that arithmetically adjusts the risk based on the integration of multiple risk factors contemplated by the AIFA’s Nota 79, including: demographic and anthropometric data, femoral and/or lumbar spine BMD T-score, family history of femoral or vertebral fractures, number and site of previous osteoporotic fracture (including vertebral, femoral, and nonvertebral nonfemoral fractures), glucocorticoid treatment (> 3 or > 12 months, ≥5 mg prednisone or equivalent), adjuvant hormone therapy for breast or prostate cancer, and comorbidities that increase the risk (rheumatoid arthritis and other connective tissue diseases, chronic obstructive pulmonary disease, inflammatory bowel diseases, Parkinson’s disease, multiple sclerosis, HIV infection, diabetes, or severe physical handicap).Results:We retrieved data for 10,235 women prescribed with an anti-osteoporotic treatment.Figure 1shows the mean 10-year fracture risk estimated with DeFRAcalc79 tool at the time of the treatment initiation. Teriparatide users had the highest 10-year risk of fracture (67.4% Standard Deviation [SD] 21.5%). We found that in 2,231 patients starting denosumab, the 10-year baseline risk of fracture was 38.5%, SD 22.8%. In 5,759 patients initiating alendronate was 25.7%, SD 15.3% and in patients initiating risedronate was 27.9%, SD 26.9%. Patients prescribed with zoledronic acid had a mean 10-year risk of fracture of 35.6%, SD 21.6. P values between means were all <0.01.Figure 1.Mean 10-year risk of fracture estimated with DeFRAcalc79 tool at the time of treatment initiation, p< 0.01 between all means.Conclusion:The risk of fracture of Italian post-menopausal women initiating different anti-osteoporotic medications varies significantly. Teriparatide is prescribed to patients with greater risk of fracture. The Nota 79 correctly individuates patients at very high risk of fracture that merit treatment with a bone anabolic. Denosumab and zoledronic acid are prescribed to patients with a greater risk of fracture compared to oral bisphosphonates.DeFRAcalc79 is a useful and practical tool for the integrated evaluation of the profile of risk of fracture.References:[1]Kanis JA et al. Algorithm for the management of patients at low, high and very high risk of osteoporotic fractures. Osteoporos Int 2019 31:1–12.https://doi.org/10.1007/s00198-019-05176-3[2]Adami G et al. Comments on Kanis et al.: Algorithm for the management of patients at low, high, and very high risk of osteoporotic fractures. Osteoporos Int. 2020. doi: 10.1007/s00198-020-05302-6. [Epub ahead of print]Disclosure of Interests:Giovanni Adami: None declared, Angelo Fassio Speakers bureau: Angelo Fassio reports personal fees from: Abiogen and Novartis, outside the submitted work., Alessandro Giollo: None declared, Giovanni Orsolini: None declared, Ombretta Viapiana: None declared, Davide Gatti Speakers bureau: Davide Gatti reports personal fees from Abiogen, Amgen, Janssen-Cilag, Mundipharma, outside the submitted work., Maurizio Rossini Speakers bureau: AbbVie, Abiogen, Amgen, BMS, Eli-Lilly, Novartis, Pfizer, Sanofi, Sandoz and UCB

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Adami, G., D. Gatti, O. Viapiana, P. Olivi, F. Bertoldo, A. Fassio, and M. Rossini. "POS1102 TEMPORAL TRENDS AND FACTORS ASSOCIATED WITH VITAMIN D PRESCRIPTION AND INTAKE." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 831.1–832. http://dx.doi.org/10.1136/annrheumdis-2021-eular.217.

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Background:Vitamin D has proven skeletal effects and its administration is recommended in patients with osteoporosis by many national and international guidelines. Nevertheless, the compliance to treatment of patients with osteoporosis is scarce. Understanding the factors associated with low vitamin D intake and prescription might help design future intervention aimed to improve adherence.Objectives:This study aims to investigate the temporal trends and factors associated with vitamin D prescription and intake.Methods:Using a web-based fracture risk-assessment tool, we collected demographic, densitometric and clinical data of women at high risk for fractures. To determine the factors associated with low vitamin D intake we ran a multivariable logistic regression analysis. We described the public general interest in the term “vitamin D” using the Google Trends tool.Results:12,419 women were included in the study. 6,748 (54.4%) individuals had a prevalent fragility fracture and 8,950 (72.1%) individuals were on <800 IU of vitamin D per day and 11,434 (92.1%) were taking <1,200 IU of vitamin D per day. The factors associated with vitamin D intake were evaluated with a multivariable logistic regression analysis, which results are presented in Table 1. We found that low BMD levels, the presence of associated comorbidities and glucocorticoid utilization were associated with greater vitamin D intake. Falls were associated only with lower risk of receiving very low dose of vitamin D (<250 IU day). Smoking status was associated with lower vitamin D intake. Overall, the internet interest in vitamin D was higher during the winter season Figure 1.Figure 1.Google trends interest in the term “vitamin D” from January 2010 to October 2020Conclusion:Low vitamin D intake (<800 IU day) was common in our cohort of women at high risk for fractures. The factors associated with greater vitamin D intake were: having low BMD levels, associated rheumatic diseases and glucocorticoid use. Falls were associated with lower risk of receiving very low dose of vitamin D (<250 IU day). Smoking status was associated with lower vitamin D intake.Table 1.Binary logistic regression to predict the risk of low vitamin D intake (<800 IU/day)>800 IU day REFaOR (95% CI)p value400-800 IU dayAge1.001 (0.995-1.007)NST-score1.422 (1.342-1.508)<0.001No comorbiditiesREFRheumatoid arthritis0.732 (0.583-0.920)<0.001Psoriatic arthritis0.362 (0.218-0.607)<0.001Connective tissue disease0.630 (0.486-0.816)<0.001No cigarette smokingREFCigarette smoking1.040 (0.893-1.212)NSAlcohol <3 unit dayREFAlcohol ≥3 unit day1.201 (0.660-2.187)NSNo glucocorticoidsREFGlucocorticoids 2.5-5 mg/day0.688 (0.550-0.860)<0.001Glucocorticoids ≥5 mg/day0.739 (0.554-0.986)<0.001No fallsREFFalls0.875 (0.754-1.015)NS250-400 IU dayAge0.994 (0.985-1.002)NST-score1.223 (1.117-1.339)<0.001No comorbiditiesREFRheumatoid arthritis0.670 (0.463-0.970)<0.001Psoriatic arthritis0.300 (0.119-0.752)<0.001Connective tissue disease0.651 (0.435-0.975)<0.001No cigarette smokingREFCigarette smoking1.371 (1.104-1.702)<0.001Alcohol <3 unit dayREFAlcohol ≥3 unit day1.824 (0.865-3.887)NSNo glucocorticoidsREFGlucocorticoids 2.5-5 mg/day0.930 (0.666-1.297)NSGlucocorticoids ≥5 mg/day0.743 (0.464-1.189)NSNo fallsREFFalls0.934 (0.741-1.176)NS<250 IU dayAge0.993 (0.988-0.998)<0.01T-score1.139 (1.079-1.202)<0.001No comorbiditiesREFRheumatoid arthritis0.645 (0.522-0.795)<0.001Psoriatic arthritis0.553 (0.376-0.812)<0.001Connective tissue disease0.697 (0.558-0.871)<0.001No cigarette smokingREFCigarette smoking1.339 (1.171-1.532)<0.001Alcohol <3 unit dayREFAlcohol ≥3 unit day1.267 (0.749-2.145)NSNo glucocorticoidsREFGlucocorticoids <5 mg/day0.964 (0.796-1.168)NSGlucocorticoids ≥5 mg/day0.946 (0.736-1.215)NSNo fallsREFFalls0.615 (0.530-0.712)<0.001Disclosure of Interests:None declared.

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Efremova, A., N. Toroptsova, N. Demin, O. Dobrovolskaya, and O. Nikitinskaya. "POS0841 RISK FACTORS OF LOW BONE MINERAL DENSITY IN WOMEN WITH SYSTEMIC SCLEROSIS." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 674.2–675. http://dx.doi.org/10.1136/annrheumdis-2021-eular.1339.

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Background:Chronic inflammatory rheumatic diseases are risk factors of bone loss and fractures. Systemic sclerosis (SSc) has been recognized to be another potential inflammatory joint disease that may affect bone tissue.Objectives:to evaluate bone mineral density (BMD) and risk factors of low BMD in women with SSc.Methods:173 women, among them 110 postmenopausal (median age 60[55,63] years) and 63 premenopausal (median age 35[31,44] years). BMD was measured at lumbar spine (LS), femoral neck (FN) and total hip (TH) by dual energy X-ray absorptiometry (DXA, Hologic 4500A). Low BMD was diagnosed if the T-score was < -1.0 standard deviation (SD) in postmenopausal women and if the Z-score was < -2.0 SD in premenopausal women. The relationship between BMD and SSc patients’ characteristics was evaluated using univariate linear regression analysis.Results:Low BMD was found in 66% patients: 79% - in postmenopausal and 18% - in premenopausal women. Among postmenopausal persons osteoporosis was discovered in 47% and osteopenia – in 32% cases. In postmenopausal woman BMD of LS, FN and TH were associated with body mass index (BMI) (β=0.27, p=0.010; β=0.47, p<0,001 and β=0.45, p<0,001, respectively), duration of glucocorticoids (GCs) using (β=-0.31, p=0.008; β=-0.34, p=0.003 and β=-0.27, p=0.022, respectively); BMD of FN and TH with C-reactive protein (β= -0.32, p=0.016 and β= -0.29, p=0.029, respectively) and LS BMD with current and cumulative GCs dose (β= -0.24, p=0.039 and β= -0.29, p=0.014, respectively). In premenopausal women BMD of LS, FN and TH were associated with BMI (β=0.51, p<0,001; β=0.45, p=0.003 and β=0.47, p=0.002, respectively), duration of GCs using (β= -0.45, p=0.004; β= -0.47, p=0.003 and β= -0.48, p=0.002, respectively) and GCs cumulative dose (β= -0.48, p=0.002; β= -0.51, p=0.001 and β= -0.46, p=0.004, respectively); BMD of FN and TH with 25(ОН)D level (β=0.52, p=0.008 and β=0.54, p=0.005, respectively), and LS BMD with SSc duration (β= -0.44, p=0.004).Conclusion:Low BMD was diagnosed in 66% of women with SSc. Low BMI, GCs cumulative dose and duration of GCs using were independent risk factors for low BMD in both premenopausal and postmenopausal persons. Additional factors as SSc duration and low vitamin D level were found out for premenopausal and current GCs dose and C-reactive protein level for postmenopausal women.Disclosure of Interests:None declared

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Lacativa, Paulo Gustavo Sampaio, and Maria Lucia Fleiuss de Farias. "Osteoporosis and inflammation." Arquivos Brasileiros de Endocrinologia & Metabologia 54, no. 2 (March 2010): 123–32. http://dx.doi.org/10.1590/s0004-27302010000200007.

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Several inflammatory diseases such as rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease, celiac disease, cystic fibrosis and chronic obstructive pulmonary disease have been associated to bone resorption. The link between osteoclast, macrophage colony stimulating factor and pro-inflammatory cytokines, especially tumor necrosis factor-α and interleukin-1 explain the association between inflammation and osteoporosis. These diseases are related to osteoporosis and high fracture risk independent of other risk factors common to inflammatory diseases such as reduced physical activity, poor nutritional status, hypovitaminosis D, decrease in calcium intake and glucocorticoid treatment. Erythrocyte sedimentation rate and C-reactive protein should always be performed, but the indication about when to perform the densitometry test should be analyzed for each disease. Bisphosphonates are nowadays the best choice of therapy but new medications such as denosumab, IL-1 receptor antagonist, and TNF-α antibody have risen as new potential treatments for osteoporosis secondary to inflammation.

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Mirzovaliev, O. Kh, and S. M. Shukurova. "Characteristics of osteoporosis in patients with rheumatic diseases." Health care of Tajikistan, no. 3 (October 29, 2021): 48–54. http://dx.doi.org/10.52888/0514-2515-2021-350-48-54.

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Aim. To present a comprehensive assessment of rheumatic diseases in association with osteoporosis.Material and methods. A retrospective analysis was made of 180 case histories with various RDs, who were under inpatient observation at the Sughd Regional Clinical Hospital for the period 2018-2019 for the frequency of osteoporosis (OP). Densitometry was used to determine the projection mineral density (in g / cm2) in various parts of the skeleton.Results. When asked about a history of fractures, every third respondent (33.3%) answered positively. According to the results of densitometry, osteoporosis in patients with inflammatory RD was diagnosed in 32.2% of patients. At the same time, the indicators differed significantly by nosology, and the frequency of OP correlated with the intake of corticosteroids. Osteoporosis was detected in every third patient with OA according to densitometry data and in 25% of cases in patients with gout. The results of the analysis to assess the absolute risk of major osteoporotic fractures according to FRAX showed high risk in 2 groups.Conclusion. Thus, the nature and frequency of risk factors for osteoporosis in patients with RA and OA have their characteristics. A history of fractures in patients with RA is often associated with long-term use of GCS, and the presence of menopause in women and the presence of cardiometabolic concomitant diseases play an important role in the progression of AP in patients with OA.

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Badea, Ionut-Andrei, Mihai Bojinca, Mihaela Milicescu, Oana Vutcanu, and Andreea-Ruxandra Ilina. "Literature review of Radiofrequency Echographic Multi-Spectrometry (REMS) in the diagnosis of osteoporosis and bone fragility." Romanian Journal of Rheumatology 31, no. 1 (March 31, 2022): 18–21. http://dx.doi.org/10.37897/rjr.2022.1.4.

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Background. Osteoporosis is a frequent comorbidity among patients with inflammatory rheumatic diseases, due to the impact of their therapies, the hish systemic inflammation and the large scale use of glucocorticoid treatment. Use of DXA and REMS. Dual X-ray Absorptiometry (DXA) is the “gold standard” for detecting patients with low bone mineral density (BMD), using Z and T scores to define the thresholds for diagnosis of osteopenia and osteoporosis, but this method has proven many disadvantages in time, especially in patients with inflammatory rheumatic diseases, those diagnosed with a disease in the spectrum of spondyloarthritides. Therefore, in the last years, a new method of evaluating bone mineral density (BMD) was developed and benefited from numerous efficiency studies: REMS (Radiofrequency Echographic Multi-Spectrometry). The basis of the method is its ability to identify and analyze native unfiltered ultrasound waves that reflect from the bone surface of the vertebra and femoral neck, the so-called echographic radiofrequency (RF) waves. The analysis of all RF waves spectra allows both a quantitative as well as a qualitative assessment of the bone, thus effectively obtaining estimates of bone resistance and evaluating fracture risk through indirect analysis of bone architecture. Conclusions. The studies concluded that REMS is a method at least as good as DXA in detecting patients with osteoporosis by applying the definitions of the World Health Organization (WHO), and also discovered many advantages of the REMS method, probably the biggest advantages being the ability of this ultrasound method of evaluating bone fragility independent of BMD by introducing the Fragility Score (FS) and the possibility of using the ultrasound method in identifying bone demineralization and fragility in pregnant women. Furthermore, numerous studies begin to recognize the usefulness of REMS in diagnosis and evolution of patients with osteoporosis and inflammatory rheumatic diseases. Discussions. A new concept that should be considered is the fact that REMS could potentially more accurately evaluate BMD and bone fragility through the FS in patients with diseases from the spectrum of spondyloarthritides(especially those with ankylosing spondylitis and psoriatic arthritis).

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Kawano, T., T. Kashiwagura, M. Kobayashi, Y. Sugimura, H. Sato, N. Miyakoshi, and Y. Shimada. "AB0899 TREATMENT STATUS OF PATIENTS WITH GLUCOCORTICOID-INDUCED OSTEOPOROSIS IN THE AKITA ORTHOPEDIC GROUP ON RHEUMATOID ARTHRITIS REGISTRY." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1753.1–1753. http://dx.doi.org/10.1136/annrheumdis-2020-eular.4280.

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Background:Glucocorticoids (GC) have potent anti-inflammatory and immunosuppressive effects and are used to treat a variety of diseases. However, GC are associated with several adverse effects. Glucocorticoid-induced osteoporosis (GIO), a bone metabolism disorder, accounts for 25% of the side effects associated with GC, and long-term use of these agents leads to fragility fractures in 30 to 50% of patients [1]. GC are frequently used to treat rheumatoid arthritis (RA). No report on the current treatment status for glucocorticoid-induced osteoporosis (GIO) has been published following the publication of the new guidelines for the management and treatment of GIO issued by the Japanese Society for Bone Mineral Research provided in 2014 (Figure 1) [2].Objectives:The present study aimed to investigate the current treatment status of GIO patients in the Akita Orthopedic Group on Rheumatoid Arthritis (AORA) registry.Methods:This retrospective, multicenter study included 683 patients (138 men, 545 women) with fracture risk factor scores ≥3 based on the new guidelines who were in the AORA registry. We examined patient characteristics, differences in patient backgrounds between treated and non-treated groups.Results:There were no significant differences in mean GC dose between men and women (4.0 ± 2.3 mg/day vs 3.6 ± 1.8 mg/day, p = 0.08). The mean disease duration of RA in women was significantly longer than in men (180.2 ± 140.2 months vs 143.8 ± 129.6 months, Untreated GIO patients were significantly more likely to be men and younger. The univariate analysis showed that clinic visits, male sex, younger age, and longer disease duration were significant risk factors for lack of therapeutic intervention for GIO. Multivariate analysis showed that being treated in a clinic, male sex, and younger age were significant risk factors for lack of therapeutic intervention for GIO.Conclusion:Our results emphasize the importance of considering the prevention and treatment of GIO in all patients with RA, including younger and male patients, who have lower intervention rates.References:[1]Weinstein RS. Clinical practice. Glucocorticoid-induced bone disease. New Engl J Med. 2011; 365(1): 62-70.[2]Suzuki Y, Nawata H, Soen S, Fujiwara S, Nakayama H, Tanaka I, et al. Guidelines on the management and treatment of glucocorticoid-induced osteoporosis of the Japanese Society for Bone and Mineral Research: 2014 update. J Bone Miner Metab. 2014; 32(4): 337-350.Disclosure of Interests:None declared

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Էֆրեմիդու, Մ․Լ, Մ․Ա Օսիպյան, Ի․Ս Ղազինյան та Ք․Վ Գինոսյան. "ԳԼՅՈՒԿՈԿՈՐՏԻԿՈԻԴ-ԻՆԴՈՒԿՑՎԱԾ ՕՍՏԵՈՊՈՐՈԶԻ ԱՐԴԻԱԿԱՆՈՒԹՅՈՒՆԸ, ԿԱՆԽԱՐԳԵԼՄԱՆ ԵՎ ԲՈՒԺՄԱՆ ԺԱՄԱՆԱԿԱԿԻՑ ՄՈՏԵՑՈՒՄՆԵՐԸ". MEDICINE, SCIENCE AND EDUCATION, № 34 (листопад 2022): 37–41. http://dx.doi.org/10.56936/18291775-2022.34-37.

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Glucocorticoid-induced osteoporosis (GIOP) is a common cause of secondary osteoporosis. The highest rate of bone loss occurs within the first 3–6 months of glucocorticoid treatment. Direct effects of glucocorticoids on bone include an early, transient increase in bone resorption and long-term suppression of bone formation. The risk of fractures is directly proportional to the duration and dosage of glucocorticoids taken. It is necessary to assess and reassess the risks of osteoporotic fractures in time and prevent their occurrence. Densitometry should be performed in patients under the age of 40 years 6 months after the start of corticosteroid therapy. For patients older than 40 years FRAX should be considered. When treating osteoporosis, it is important to take into account such factors as the age of the patient, the history of fractures or osteoporosis, the duration of administration and cumulative dosage of glucocorticoids, concomitant diseases, the risk of fracture, etc. Bisphosphonates are the first-line treatment option for the prevention of fracture in patients receiving glucocorticoids. If oral bisphosphonates are ineffective, intravenous bisphosphonates are used for treatment. Teriparatide and denosumab are considered as second-line drugs. It is also important to educate patients to lead a healthy lifestyle.

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Su, Yu-Jih, Chao Tung Chen, Nai-Wen Tsai, Chih-Cheng Huang, Hung-Chen Wang, Chia-Te Kung, Wei-Che Lin, et al. "The Role of Monocyte Percentage in Osteoporosis in Male Rheumatic Diseases." American Journal of Men's Health 11, no. 6 (September 13, 2017): 1772–80. http://dx.doi.org/10.1177/1557988317721642.

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Osteoporosis is easily overlooked in male patients, especially in the field of rheumatic diseases mostly prevalent with female patients, and its link to pathogenesis is still lacking. Attenuated monocyte apoptosis from a transcriptome-wide expression study illustrates the role of monocytes in osteoporosis. This study tested the hypothesis that the monocyte percentage among leukocytes could be a biomarker of osteoporosis in rheumatic diseases. Eighty-seven males with rheumatic diseases were evaluated in rheumatology outpatient clinics for bone mineral density (BMD) and surrogate markers, such as routine peripheral blood parameters and autoantibodies. From the total number of 87 patients included in this study, only 15 met the criteria for diagnosis of osteoporosis. Both age and monocyte percentage remained independently associated with the presence of osteoporosis. Steroid dose (equivalent prednisolone dose) was negatively associated with BMD of the hip area and platelet counts were negatively associated with BMD and T score of the spine area. Besides age, monocyte percentage meets the major requirements for osteoporosis in male rheumatic diseases. A higher monocyte percentage in male rheumatic disease patients, aged over 50 years in this study, and BMD study should be considered in order to reduce the risk of osteoporosis-related fractures.

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Cabling, Marven G., Vaneet K. Sandhu, Christina D. Downey, and Karina D. Torralba. "Cardiovascular disease and bone health in aging female rheumatic disease populations: A review." Women's Health 19 (January 2023): 174550572311552. http://dx.doi.org/10.1177/17455057231155286.

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Rheumatic diseases cover a wide spectrum of conditions, including primary and secondary degenerative joint diseases and autoimmune inflammatory rheumatic diseases. The risks of cardiovascular disease and osteoporosis and resultant fractures in aging female rheumatic disease populations, especially those with autoimmune rheumatic diseases, are increased. Changes in the immune system in aging populations need to be considered especially among patients with autoimmune rheumatic diseases. Immunosenescence is closely aligned to reduced adaptive immunity and increased non-specific innate immunity leading to chronic inflammation of inflammaging. The effective use of disease-modifying antirheumatic drugs to control autoimmune rheumatic diseases may also mitigate factors leading to cardiovascular disease and osteoporosis. Rheumatic diseases, which largely manifest as arthritis, predispose patients to premature joint degeneration and poor bone health and therefore have a higher risk of developing end-stage arthritis requiring joint arthroplasties sooner or more often than other patients without rheumatic disease.

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Sirufo, Maria Maddalena, Francesca De Pietro, Enrica Maria Bassino, Lia Ginaldi, and Massimo De Martinis. "Osteoporosis in Skin Diseases." International Journal of Molecular Sciences 21, no. 13 (July 3, 2020): 4749. http://dx.doi.org/10.3390/ijms21134749.

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Osteoporosis (OP) is defined as a generalized skeletal disease characterized by low bone mass and an alteration of the microarchitecture that lead to an increase in bone fragility and, therefore, an increased risk of fractures. It must be considered today as a true public health problem and the most widespread metabolic bone disease that affects more than 200 million people worldwide. Under physiological conditions, there is a balance between bone formation and bone resorption necessary for skeletal homeostasis. In pathological situations, this balance is altered in favor of osteoclast (OC)-mediated bone resorption. During chronic inflammation, the balance between bone formation and bone resorption may be considerably affected, contributing to a net prevalence of osteoclastogenesis. Skin diseases are the fourth cause of human disease in the world, affecting approximately one third of the world’s population with a prevalence in elderly men. Inflammation and the various associated cytokine patterns are the basis of both osteoporosis and most skin pathologies. Moreover, dermatological patients also undergo local or systemic treatments with glucocorticoids and immunosuppressants that could increase the risk of osteoporosis. Therefore, particular attention should be paid to bone health in these patients. The purpose of the present review is to take stock of the knowledge in this still quite unexplored field, despite the frequency of such conditions in clinical practice.

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Radeva, Maria, Dorothee Predel, Sven Winzler, Ulf Teichgräber, Alexander Pfeil, Ansgar Malich, and Ismini Papageorgiou. "Reliability of a Risk-Factor Questionnaire for Osteoporosis: A Primary Care Survey Study with Dual Energy X-ray Absorptiometry Ground Truth." International Journal of Environmental Research and Public Health 18, no. 3 (January 28, 2021): 1136. http://dx.doi.org/10.3390/ijerph18031136.

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(1) Purpose: Predisposing factors to osteoporosis (OP) as well as dual-source x-ray densitometry (DXA) steer therapeutic decisions by determining the FRAX index. This study examines the reliability of a standard risk factor questionnaire in OP-screening. (2) Methods: n = 553 eligible questionnaires encompassed 24 OP-predisposing factors. Reliability was assessed using DXA as a gold standard. Multiple logistic regression and Spearman’s correlations, as well as the confounding influence of age and body mass index, were analyzed in SPSS (IBM Corporation, Armonk, NY, USA). (3) Results: Our study revealed low patient self-awareness regarding OP and its risk factors. One out of every four patients reported a positive history for osteoporosis not confirmed by DXA. The extraordinarily high incidence of rheumatoid arthritis and thyroid disorders likely reflect confusion with other diseases or health anxiety. FRAX-determining risk factors such as malnutrition, liver insufficiency, prior fracture without trauma, and glucocorticoid therapy did not correlate with increased OP incidence, altogether demonstrating how inaccurate survey information could influence therapeutic decisions on osteoporosis. (4) Conclusions: Contradictive results and a low level of patient self-awareness suggest a high degree of uncertainty and low reliability of the current OP risk factor survey.

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Sorokina, A. O., N. V. Demin, O. V. Dobrovolskaya, O. A. Nikitinskaya, N. V. Toroptsova, and A. Yu Feklistov. "Pathological phenotypes of body composition in patients with rheumatic diseases." Rheumatology Science and Practice 60, no. 4 (September 7, 2022): 487–94. http://dx.doi.org/10.47360/1995-4484-2022-487-494.

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Aim – to identify the frequency of isolated and combined pathological phenotypes of body composition in women with rheumatic diseases and to determine the factors associated with the sarcopenic phenotype.Materials and methods. 255 women (median age 60 [54; 64] years) were included in the study: 114 patients with rheumatoid arthritis (RA), 46 – with systemic sclerosis (SSc), 56 – with osteoarthritis (OA), and 39 persons without rheumatic diseases (control). Questionnaires, anthropometric measurements, double-energy X-ray absorptiometry of the whole body, lumbar spine and proximal femur were performed. The assessment of the factors associated with the sarcopenic phenotype was carried out using a univariate regression analysis.Results. The frequency of isolated and combined pathological phenotypes in women with SSc was 34.8% and 52.2%, with RA – 51.8% and 38.6%, with OA – 71.4% and 10.7%, respectively. The sarcopenic phenotype was more often determined in patients with SSc (43.5%) and RA (29.8%) compared with women with OA (1.8%) (p<0.001). The factors associated with the sarcopenic phenotype were BMI><25 kg/m2 (OR=7.89 [95% CI: 3.90–15.96]; p><0.001), glucocorticoids (GC) intake (OR=2.50 [95% CI: 1.32–4.73]; p=0.005) and cumulative GC dose (OR=1.04 [95% CI: 1.01–1.07]; p=0.008), presence of osteoporosis (OP) (OR=4.31 [95% CI: 2.33–7.97]; p><0.001), leukocytosis more than 9.0×109 /l (OR=4.08 [95% CI: 1.38–12.10]; p=0.011), total protein less than 65 g/l (OR=1.11 [95% CI: 1.02–1.19]; p=0.019) and calcium intake less than 500 mg/day (OR=2.78 [95% CI: 1.39–5.53]; p=0.004). Conclusion. The study demonstrated a significant frequency of pathological phenotypes of body composition in women with rheumatic diseases, while combined phenotypes were more common in patients with SSc and RA compared with patients with OA. The probability of sarcopenic phenotype increased with BMI><25 kg/m2 , GC using, the presence of OP and insufficiency of calcium intake. Key words: rheumatic diseases, body composition phenotypes, sarcopenia, osteoporosis, osteosarcopenia, overfat, rheumatoid arthritis, systemic scleroderma, osteoarthritis, risk factors>˂ 0.001). The factors associated with the sarcopenic phenotype were BMI<25 kg/m2 (OR=7.89 [95% CI: 3.90–15.96];>˂ 25 kg/m2 (OR=7.89 [95% CI: 3.90–15.96]; p<0.001), glucocorticoids (GC) intake (OR=2.50 [95% CI: 1.32–4.73]; p=0.005) and cumulative GC dose (OR=1.04 [95% CI: 1.01–1.07]; p=0.008), presence of osteoporosis (OP) (OR=4.31 [95% CI: 2.33–7.97]; p><0.001), leukocytosis more than 9.0×109 /l (OR=4.08 [95% CI: 1.38–12.10]; p=0.011), total protein less than 65 g/l (OR=1.11 [95% CI: 1.02–1.19]; p=0.019) and calcium intake less than 500 mg/day (OR=2.78 [95% CI: 1.39–5.53]; p=0.004). Conclusion. The study demonstrated a significant frequency of pathological phenotypes of body composition in women with rheumatic diseases, while combined phenotypes were more common in patients with SSc and RA compared with patients with OA. The probability of sarcopenic phenotype increased with BMI><25 kg/m2 , GC using, the presence of OP and insufficiency of calcium intake. Key words: rheumatic diseases, body composition phenotypes, sarcopenia, osteoporosis, osteosarcopenia, overfat, rheumatoid arthritis, systemic scleroderma, osteoarthritis, risk factors>˂ 0.001), glucocorticoids (GC) intake (OR=2.50 [95% CI: 1.32–4.73]; p=0.005) and cumulative GC dose (OR=1.04 [95% CI: 1.01–1.07]; p=0.008), presence of osteoporosis (OP) (OR=4.31 [95% CI: 2.33–7.97]; p<0.001), leukocytosis more than 9.0×109 /l (OR=4.08 [95% CI: 1.38–12.10]; p=0.011), total protein less than 65 g/l (OR=1.11 [95% CI: 1.02–1.19]; p=0.019) and calcium intake less than 500 mg/day (OR=2.78 [95% CI: 1.39–5.53]; p=0.004).>˂ 0.001), leukocytosis more than 9.0×109 /l (OR=4.08 [95% CI: 1.38–12.10]; p=0.011), total protein less than 65 g/l (OR=1.11 [95% CI: 1.02–1.19]; p=0.019) and calcium intake less than 500 mg/day (OR=2.78 [95% CI: 1.39–5.53]; p=0.004).Conclusion. The study demonstrated a significant frequency of pathological phenotypes of body composition in women with rheumatic diseases, while combined phenotypes were more common in patients with SSc and RA compared with patients with OA. The probability of sarcopenic phenotype increased with BMI<25 kg/m2 , GC using, the presence of OP and insufficiency of calcium intake. Key words: rheumatic diseases, body composition phenotypes, sarcopenia, osteoporosis, osteosarcopenia, overfat, rheumatoid arthritis, systemic scleroderma, osteoarthritis, risk factors>˂ 25 kg/m2, GC using, the presence of OP and insufficiency of calcium intake.

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45

Falcini, Fernanda, Sandra Trapani, Marialisa Ermini, and Giorgio Bartolozzi. "Deflazacort in Pediatric Rheumatic Diseases Needs a Frequent Follow-up of Bone Densitometry." Pediatrics 95, no. 2 (February 1, 1995): 318. http://dx.doi.org/10.1542/peds.95.2.318.

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Osteoporosis is the most important side effect of long-term steroid treatment.1 Fractures are a frequent consequence of osteoporosis and mainly affect the spine (height loss, kyphosis, severe acute or chronic back pain, and complete immobility).2 In children the management of this complication is difficult particularly when a full dose of steroids is required to control the underlying disease. Recently it has been suggested that Deflazacort (DFL), an oxazolinic acid derivative of prednisone, may have a bone sparing effect when compared with prednisone.3

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46

Tatsuno, Ichiro, Takao Sugiyama, Sawako Suzuki, Tomohiko Yoshida, Tomoaki Tanaka, Makoto Sueishi, and Yasushi Saito. "Age Dependence of Early Symptomatic Vertebral Fracture with High-Dose Glucocorticoid Treatment for Collagen Vascular Diseases." Journal of Clinical Endocrinology & Metabolism 94, no. 5 (May 1, 2009): 1671–77. http://dx.doi.org/10.1210/jc.2008-1578.

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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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47

Sambrook, Philip N., and Piet Geusens. "The epidemiology of osteoporosis and fractures in ankylosing spondylitis." Therapeutic Advances in Musculoskeletal Disease 4, no. 4 (June 13, 2012): 287–92. http://dx.doi.org/10.1177/1759720x12441276.

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Bone is a target in many inflammatory rheumatic diseases. Inflammation leads to a wide range of changes in bone, and especially bone remodeling. In ankylosing spondylitis (AS) bone loss has been documented, but measuring bone density in the spine is hampered by new bone formation in syndesmophytes, periost and within the vertebrae. The risk of vertebral fractures is increased in AS. The diagnosis of vertebral fractures requires imaging and adequate evaluation of vertebral heights. In addition, in the ankysosed spine segments, additional imaging is often needed to diagnose spinal fractures at unusual locations (cervical spine) or in the posterior arch structures. Risk factors for vertebral fractures are helpful for case finding. Fracture prevention is indicated in high risk patients with AS, especially when they have already a vertebral fracture or in the presence of osteoporosis.

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48

Baranova, I. A., O. B. Ershova, E. Kh Anaev, T. N. Anikhina, O. N. Anoshenkova, S. Z. Batyn, E. A. Belyaeva, et al. "PREVALENCE AND RISK FACTORS OF LOW-ENERGY SKELETAL FRACTURES IN PATIENTS WITH CHRONIC INFLAMMATORY DISEASES. THE RESULTS OF A MULTICENTER STUDY OF THE RUSSIAN ASSOCIATION ON OSTEOPOROSIS GLUKOST." Osteoporosis and Bone Diseases 17, no. 3 (December 15, 2014): 9–14. http://dx.doi.org/10.14341/osteo201439-14.

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Objectives. This study is a part of GLUKOST study hosted and organized by the Russian Association of Osteoporosis. The aim was to estimate the incidence and risk factors of fractures in patients with chronic inflammatory diseases. Materials and Methods. A specially designed questionnaire was introduced to patients with chronic inflammatory diseases in different regions of Russia. The study included 2342 patients aged 18 to 89 years (mean age 53.02 ± 14.03 years, 591 men and 1181 women). The patients were allocated into two groups: group 1 (n = 1402) - patients never prescribed oral long acting glucocorticoids (OGC); group 2 (n = 929) - patients who received oral long acting glucocorticoids for more than 2 months or continue to take at the time of the survey. The median duration of OGC therapy was 3 years, the median daily dose - 10 mg of prednisone or equivalent. Results. Low-energy fractures of the skeleton were identified in 9.0% of patients not receiving therapy OGC, and 15.5% of patients receiving or previously treated with this therapy. Significant risk factor for fractures was the length of a chronic inflammatory disease. OGC therapy increased the risk (adjusted odds ratio (95% confidence interval (95% CI)) of osteoporotic fractures, regardless of their location by 2.2-fold (95% CI 1.63-3.02, p <0,001), vertebral fractures - by 5.0 - fold (95% CI 2.05-12.37, p <0.001), distal forearm 1.8-fold (95% CI 1.10-2.84, p = 0.02). The frequency of fractures in group 2 was increased in men and women of different age groups, but a significant increase in risk was demonstrated only in postmenopausal women and men 50 years and older. We were unable to identify a relationship of fractures with a daily dose of OGC. Conclusion. The main risk factors for osteoporotic fractures in patients with chronic inflammatory diseases are age, duration of the underlying disease, and long-term use of oral glucocorticoids.

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Hofbauer, Lorenz C., Christine Hamann, and Peter R. Ebeling. "Approach to the patient with secondary osteoporosis." European Journal of Endocrinology 162, no. 6 (June 2010): 1009–20. http://dx.doi.org/10.1530/eje-10-0015.

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AbstractSecondary osteoporosis is characterized by low bone mass with microarchitectural alterations in bone leading to fragility fractures in the presence of an underlying disease or medication. Scenarios that are highly suspicious for secondary osteoporosis include fragility fractures in younger men or premenopausal women, very low bone mineral density (BMD) values, and fractures despite anti-osteoporotic therapy. An open-minded approach with a detailed history and physical examination combined with first-line laboratory tests are aimed at identifying clinical risk factors for fractures, osteoporosis-inducing drugs, and underlying endocrine, gastrointestinal, hematologic, or rheumatic diseases, which then need to be confirmed by specific and/or more invasive tests. BMD should be assessed with bone densitometry at the hip and spine. Lateral X-rays of the thoracic and lumbar spine should be performed to identify or exclude prevalent vertebral fractures which may be clinically silent. Management of secondary osteoporosis includes treatment of the underlying disease, modification of medications known to affect the skeleton, and specific anti-osteoporotic therapy. Calcium and vitamin D supplementation should be initiated with doses that result in normocalcemia and serum 25-hydroxyvitamin D concentrations of at least 30 ng/ml. Oral and i.v. bisphosphonates are effective and safe drugs for most forms of secondary osteoporosis. Severe osteoporosis may require the use of teriparatide.

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Papichev, E., В. Zavodovsky, A. Yury, S. L, and P. J. "AB0101 ASSOCIATION OF FETUIN-A SERUM LEVEL AND GLUCOCORTICOIDS INTAKE IN PATIENTS WITH RHEUMATOID ARTHRITIS." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1350.2–1350. http://dx.doi.org/10.1136/annrheumdis-2020-eular.1663.

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Background:Fetuin-A (FA) is a pluripotential glycoprotein, which plays an important role in bone turnover [1], inflammation, metabolic diseases [2] and etc. Several studies demonstrated association between FA serum level and rheumatoid arthritis (RA) severity and disease activity [3], however, there was made a suggestion that observed associations were due to glucocorticoids intake [4].Objectives:To study the association of serum FA levels, glucocorticoids intake and RA activity.Methods:81 patients with RA verified by ACR/EULAR 2010 criteria were enrolled in our study. 43 patients were under glucocorticoid therapy with mean cumulative dose 7899±9029,4 mg (hereinafter M±SD) and 38 patients were not. DAS28 index was calculated to determine RA activity. FA serum concentrations were measured by ELISA. Correlations between serum FA levels and RA activity were assessed in each group. Statistic analysis was performed using software package “Statistica 10.0”.Results:The mean level of serum FA was 760,72±112,56 µg/ml. There was a negative correlation between FA serum level and DAS28 index (r=-0,433; p<0,0001) when calculated among all patients. We observed positive correlation between FA serum level and cumulative dosage of glucocorticoids (r=0,297; p=0,008). At the same time FA serum level and DAS28 index were correlated negatively in patients who were under glucocorticoid therapy (r=-0,419; p<0,0001) and were not (r=-0,559; p=0,001).Conclusion:Serum FA level correlates with RA disease activity and glucocorticoids intake. However, the association between FA serum level and RA disease activity was independent of glucocorticoids intake in our study.References:[1]Akhverdyan Y., Zavodovsky B., Polyakova J., et al. Level of biochemical markers of bone metabolism in patients with osteoporosis in the presence on rheumatoid arthritis. Osteoporosis international 2019; 30(Suppl. 2): S:303.[2]Bilgir O, Kebapcilar L, Bilgir F, et al; Decreased serum fetuin-A levels are associated with coronary artery diseases. Intern Med 2010; 49(13): 1281-5.[3]Polyakova Y., Papichev E., Kvlividze T., et al. Tissue cytokines and their role in the pathogenesis of rheumatic diseases. Osteoporosis international 2019; 30 (Suppl. 2): S:387.[4]Tekeoglu I, Harman H, Sag S, et al. Levels of serum pantraxin 3, IL-6, fetuin A and insulin in patients with rheumatoid arthritis. Cytokine 2016; 83: 171-75.Disclosure of Interests:None declared

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