Research
Print page Print page
Switch language
The Capital Region of Denmark - a part of Copenhagen University Hospital
Published

The effect of glucocorticoids on bone mineral density in patients with rheumatoid arthritis: A systematic review and meta-analysis of randomized, controlled trials

Research output: Contribution to journalJournal articleResearchpeer-review

  1. Aging and lineage allocation changes of bone marrow skeletal (stromal) stem cells

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Hyponatremia and metabolic bone disease in patients with epilepsy: A cross-sectional study

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Comparison of bone turnover markers in peripheral blood and bone marrow aspirate

    Research output: Contribution to journalJournal articleResearchpeer-review

  4. A specific subtype of osteoclasts secretes factors inducing nodule formation by osteoblasts

    Research output: Contribution to journalJournal articleResearchpeer-review

  5. Paget's disease of the bone after treatment with Denosumab: a case report

    Research output: Contribution to journalJournal articleResearch

  • Anne-Birgitte Garm Blavnsfeldt
  • Annette de Thurah
  • Malissa Dawn Thomsen
  • Simon Tarp
  • Bente Langdahl
  • Ellen-Margrethe Hauge
View graph of relations

PURPOSE: The role of glucocorticoids in the treatment of rheumatoid arthritis (RA) is widely debated. Impairment of bone formation may be counter-balanced by reduced systemic inflammation. This review aims to assess the effect of prednisolone/prednisone on bone mineral density (BMD) in patients with RA analyzed in randomized, controlled trials.

METHODS: We performed a systematic literature search and identified randomized, double-blinded placebo-controlled studies including patients with RA and using prednisolone or prednisone as the intervention. We selected studies that measured BMD by DXA at baseline and at least once thereafter. Two authors independently performed reference review, data extraction and risk of bias assessment. Primary outcome was mean change in BMD from baseline to follow-up. Secondary endpoints included radiographic scores, RA disease activity indices and fractures. We rated the quality of evidence using the GRADE approach. Outcomes were standardized for meta-analyses and 95% confidence intervals (95% CI) were calculated.

RESULTS: We identified 7 studies and included previously unpublished data. Studies were similar regarding study population and intervention. Standard mean difference (SMD) in change in BMD from 0 to 24 months was -0.02 (95%CI -0.16, 0.12) at the lumbar spine and -0.11 (95% CI -0.25, 0.02) at the hip (both high quality evidence) between patients treated with prednisolone/prednisone or not. Data completeness was low in some studies, concomitant treatment of RA differed between studies and differences in use of anti-osteoporotic medication may have influenced the results. However, sensitivity analyses excluding studies in which participants used either the most or the least potent concomitant RA treatment or used anti-osteoporotic therapies did not alter the estimates.

CONCLUSIONS: In patients with early and active RA, we found no difference in change in BMD between patients treated with prednisone/prednisolone versus placebo, suggesting that at least through 24 months, the suppression of inflammation by glucocorticoids may counterbalance their adverse effects on bone remodeling.

Original languageEnglish
JournalThe Bone
Volume114
Pages (from-to)172-180
Number of pages9
ISSN0914-7047
DOIs
Publication statusPublished - Sep 2018

ID: 56060629