Abstract
We aimed to evaluate the compliance of physicians with the 2014 guidelines of the Japanese Society for Bone and Mineral Research, for the prevention and treatment of glucocorticoid (GC) induced osteoporosis (GIO) and to investigate the risk of fracture and other associated risk factors in bisphosphonate-treated patients. We evaluated 90 female patients with nonrheumatoid arthritis autoimmune diseases who received long-term GC treatment (≥12 months). Clinical characteristics, including age, GC dose, history of fragility fractures, osteoporosis treatments, as well as lumbar (L2–L4) and femoral neck bone mineral density, were collected from the patients' medical charts. New vertebral fractures during the study period were evaluated using thoracic and lumbar spine radiographs by quantitative measurements. The GIO score was calculated for each patient according to 2014 Japanese guidelines. Of the 90 patients evaluated, 60 were indicated for osteoporosis treatment, based on the 2014 guidelines of Japan. We observed a high compliance rate, with 93% of patients receiving osteoporosis treatment and 50% receiving bisphosphonates. In total, eight patients developed new vertebral fractures during the study, six of whom received bisphosphonates. In bisphosphonate-treated patients, fracture risk was associated with GC treatment and a lack of active vitamin D3 supplementation. The compliance rate with the updated Japanese 2014 guidelines at our institution was very high. Large randomized controlled trials are needed to confirm our findings that suggest that active vitamin D3 should be used in combination with bisphosphonates for the treatment of GIO to reduce fracture risk.
Highlights
Glucocorticoids (GCs), which have anti-inflammatory and immunosuppressive effects, are widely used to treat various diseases, including autoimmune disorders
Eleven patients had a history of vertebral fracture before the initial examination at our hospital. e mean lumbar and femoral neck bone mineral density (BMD) measurements recorded at the final observation were 95.7% and 87%, respectively
Long-term GC use is associated with various side effects, we found that 97 out of 152 patients (63.8%) with autoimmune diseases, excluding rheumatoid arthritis (RA), continued to receive GC treatment in our clinic. e side effects of GC are diverse and can affect the whole body; among them, GC-induced osteoporosis (GIO) and secondary vertebral fractures are the most severe adverse events that significantly affect a patient’s quality of life [2]
Summary
Glucocorticoids (GCs), which have anti-inflammatory and immunosuppressive effects, are widely used to treat various diseases, including autoimmune disorders. GIO is characterized by a dose-dependent risk of fracture and loss of bone mineral density (BMD) in the lumbar spine and femoral neck that peaks during the first 3–6 months of GC treatment [2]. E JSBMR 2004 guidelines recommend antiosteoporosis treatment for patients with previous, or new fragility fractures, as well as those with a BMD ≤80% of the young adult mean (YAM) [5]. Adherence to these guidelines was only 23.3%, possibly because of the low rate of BMD measurements in clinical settings [6]. In 2014, the JSBMR identified age, GC dose, lumbar spine BMD, and a history of fragility fractures as independent risk factors for new fractures and Journal of Osteoporosis incorporated these risk factors into a new scoring system to increase compliance [7]
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