Abstract
PurposeTo investigate the association between glucocorticoid-induced osteoporosis and myasthenia gravis (MG) using a cross-sectional survey in Japan.MethodsWe studied 363 patients with MG (female 68%; mean age, 57 ± 16 years) who were followed at six Japanese centers between April and July 2012. We evaluated the clinical information of MG and fractures, bone markers, and radiological assessment. Quality of life was measured using an MG-specific battery, MG-QOL15.ResultsGlucocorticoids were administered in 283 (78%) of 363 MG patients. Eighteen (6%) of 283 MG patients treated with prednisolone had a history of osteoporotic fractures. The duration of glucocorticoid therapy, but not the dose of prednisolone, was associated with the osteoporotic fractures in MG patients. Bone mineral density was significantly decreased in the MG patients with fractures. The multivariate analyses showed that the total quantitative MG score was the only independent factor associated with osteoporotic fractures (OR = 1.30, 95% CI 1.02–1.67, p = 0.03). MG patients who had experienced fractures reported more severe difficulties in activities of daily living.ConclusionGlucocorticoid-induced osteoporosis aggravates quality of life in patients with MG.
Highlights
Glucocorticoids are widely used to treat a variety of systemic autoimmune diseases
Eighteen (6%) of 283 myasthenia gravis (MG) patients treated with prednisolone had a history of osteoporotic fractures
Bone mineral density was significantly decreased in the MG patients with fractures
Summary
Glucocorticoids are widely used to treat a variety of systemic autoimmune diseases. Various side effects of long-term treatment, such as osteoporosis, represent an important problem. The risk of glucocorticoid-induced osteoporosis appears to be similar in men and women, and consequent osteoporotic fractures and impairments of activities of daily living result in huge economic losses at the national level [1]. Patients with autoimmune disease may have a high risk of osteoporotic fracture. A meta-analysis revealed bone mineral density loss after long-term treatment with low-dose glucocorticoids in patients with rheumatoid arthritis [2]. The cumulative glucocorticoids used in the treatment of systemic lupus erythematosus have been significantly associated with the development of osteoporotic fractures [3]
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