Abstract 77: BMD, TBS and HSA in chronic glucocorticoid users attending a tertiary centre in Southern India

Abstract

Background: Glucocorticoids (GC) are used for various chronic medical conditions and is one of the most abused drugs in India. Despite widespread GC use, there is lack of knowledge among physicians regarding assessment and management of glucocorticoid induced osteoporosis (GIO). This study was performed to assess bone mineral density (BMD), trabecular bone score (TBS) and hip structural analysis (HSA) in chronic steroid users.Methods: Observational study done from 2013-2020. Details of patients were obtained through archived medical records. Bone biochemical parameters and densitometric variables that included bone mineral density (BMD), trabecular bone score (TBS) and hip structural analysis (HSA) were assessed by a DXA scan.Results: A total of 74 subjects (56 females, 45/56 postmenopausal) with a mean (SD) age and BMI of 49.5 (12.5) years, 29.0 (6.9) kg/m2 were studied. Vitamin D deficiency was present in 33/74 (44.6%) of subjects. 15 subjects (20.3%) had sustained fragility fractures. At baseline, the prevalence of osteoporosis at NOF and lumbar spine was 24/74 (32.4%) and 34/74 (45.9%) respectively. Degraded trabecular microarchitecture as defined by a TBS <1.200 was present in 32/74 (43.2%) of the subjects. Among those with normal BMD at the lumbar spine, 13/40 (32.5%) had a low TBS. Buckling ratio (BR) at the narrow (NN) neck > 10 was seen in 57/74 (77%) of subjects. Among subjects with normal BMD at the femoral neck, 33/50 (66%) had a BR at NN >10, which indicates high fracture risk.Conclusion: GIO continues to be prevalent among steroid users. TBS and HSA may confer additional benefit regarding bone health, not conveyed by conventional BMD assessment in chronic glucocorticoid users.