Glucocorticoid Cumulative Dose Has No Effect on BMD, Fracture Risk in Psoriasis, PsA

bone osteoporosis fracture
bone osteoporosis fracture
The objective of this cross-sectional analysis was to evaluate the prevalence of osteoporosis and frequency of fractures in patients with psoriasis or psoriatic arthritis.
The following article is part of conference coverage from the European League Against Rheumatism (EULAR) Congress 2018 in Amsterdam, The Netherlands. Rheumatology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in rheumatology. Check back for the latest news from EULAR 2018.

Cumulative glucocorticoid dose appears to have no measurable effect on bone mineral density (BMD) and risk for osteoporotic fractures in patients with psoriasis and psoriatic arthritis (PsA), according to study results reported at the European League Against Rheumatism (EULAR) Congress,  held June 13 to 16, 2018 in Amsterdam.

Current reports on prevalence of osteoporosis and osteoporotic fractures in this population are not abundant and have been contradictory. In order to better understand potential risk factors for fractures, researchers evaluated data from 55 patients with psoriasis or PsA as part of the ongoing Rh-GIOP clinical trial (Glucocorticoid-induced Osteoporosis in Patients With Chronic Inflammatory Rheumatic Diseases or Psoriasis; Identifier: NCT02719314). The investigators sought to explore the potential roles of glucocorticoid dose, smoking, and vitamin D status in fracture risk.

Overall, 69% of the patient population included in the study were women, with a mean age of 60 years. Mean disease duration was 16±13 years; patients generally had good functional status as measured by the Health Assessment Questionnaire. Osteoporosis and osteopenia were present in 70% of patients with psoriasis and in 45% of patients with PsA, and osteoporotic fractures were present in 33% of the total cohort. Notably, family history of osteoporosis was positive in 20% of all patients. In addition, 27% and 32% of patients were current or former smokers, respectively, and 60% of all patients had vitamin D levels <75 mmol/l.

Overall, 27% of patients in the cohort were treated with glucocorticoids, with a mean daily dose of 3±8 mg, and a mean cumulative dose of 10.9±20.3 g. The investigators observed no significant difference in BMD between patients with a cumulative glucocorticoid dose >10 g vs <10 g.

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When examining other risk factors, the investigators found that neither smoking status nor vitamin D deficiency had a measurable effect on BMD. Notably, mean body mass index of the cohort was 28.9±5.9 kg/m2, and a higher body mass index had a positive correlation with BMD (P =.01).

“According to current literature, the prevalence of osteoporosis seems to be in the same range [in this population] as in the normal population,” the investigators noted. They concluded that further investigations with larger cohorts are necessary to corroborate their findings.

Disclosures: All authors report grant and research support from Amgen, BMS, Celgene, Generic Assays GSK, Horizon, medac, Mundipharma, Pfizer, and Roche.

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Freier D, Zeiner K, Biesen R, et al. Bone mineral density and fracture frequencies in patients with psoriasis or psoriasis arthritis. Presented at: European League Against Rheumatism (EULAR) Congress 2018; June 13-16, 2018; Amsterdam, The Netherlands. Abstract AB0915.