Sex and age do not modify the association between glucocorticoids and bone mineral density in patients with rheumatoid arthritis: a cross-sectional study

Andriko Palmowski, Zhivana Boyadzhieva, Sabrina M Nielsen, Burkhard Muche, Sandra Hermann, Maarten Boers, Henning Bliddal, Robin Christensen, Edgar Wiebe, Frank Buttgereit

Abstract

BACKGROUND: It is unclear whether sex or age modify the association of glucocorticoid (GC) use with reduced bone mineral density (BMD) in patients with rheumatoid arthritis (RA).

METHODS: We studied cross-sectional data of RA patients with current or previous GC treatment in a single center cohort study (Rh-GIOP cohort). Our primary outcome was the minimum T-score (measured by DXA) of either lumbar spine, total femur, or femoral neck. Current GC dose was the main exposure; cumulative GC dose and cumulative duration of GC use were also assessed. Following a predefined statistical analysis plan, linear regression analyses with adjustment for confounders assessed whether the association of GC use with BMD was modified by sex (men versus women) or age (≥ 65 versus < 65 years).

RESULTS: Four hundred eighty-three patients with RA (mean age 64 ± 12 years, 80% women) were included. 33% were not currently taking GCs, 32% were treated with a dose of 5 mg/d prednisone equivalent and 11% with more than 7.5 mg/d. 23% of patients had osteoporosis by DXA (minimum T-score ≤ -2.5). The slope, i.e., the association between changes in minimum T-scores with 1 mg/d change in current GC dose, was similar in men and women (-0.07 and -0.04, respectively; difference -0.03 [-0.11 to 0.04]; p for interaction = 0.41). Slopes were also similar for elderly and non-elderly patients (-0.03 and -0.04, respectively; difference -0.01 [-0.06 to 0.05]; p for interaction = 0.77). Using cumulative dose and duration of use as exposures did not lead to substantial changes of these results.

CONCLUSIONS: In our sample, the association of GC use with reduced BMD in RA was not modified by sex or age.

Original languageEnglish
Article number98
JournalArthritis Research & Therapy
Volume25
Issue number1
Pages (from-to)98
ISSN1478-6354
DOIs
Publication statusPublished - 7 Jun 2023

Keywords

  • Male
  • Humans
  • Female
  • Middle Aged
  • Aged
  • Bone Density
  • Glucocorticoids/therapeutic use
  • Cross-Sectional Studies
  • Cohort Studies
  • Arthritis, Rheumatoid/drug therapy
  • Lumbar Vertebrae/diagnostic imaging
  • Absorptiometry, Photon

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