An Observational Study on the Influence of Glucocorticoid Exposure on Bone

Joseph Heath¹, Alexander Oldroyd², Maarten Boers³ and Marwan Bukhari², ¹Faculty of health and medicine, Lancaster University, Lancaster, United Kingdom, ²Lancaster Medical School, Lancaster University, Lancaster, United Kingdom, ³Dep of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Bone density, corticosteroids, fracture risk and osteoporosis

Session Information

Title: Osteoporosis and Metabolic Bone Disease - Clinical Aspects and Pathogenesis: Osteoporosis: Pathogenesis, Epidemiology and Diagnosis

Session Type: Abstract Submissions (ACR)

Background/Purpose

It is well known that glucocorticoids are detrimental to bone health and has been postulated that their influence is more than their effect on reduction of bone mineral density (BMD). This has not been localised to type of bone involved as trabecular bone and cortical bone differ. The FRAX ™ tool uses the hip BMD as a predictor of future fracture risk, which is a measure of cortical rather than trabecular bone. Recently, we have shown that hip structure analysis (HSA) is also e predictor of fracture. We aimed to study in an observational manner the effect of corticosteroid (CS) use on the bone in the lumbar spine (trabecular bone) and the hip (cortical bone), in addition to any differences in HSA.

Methods

Patients who are identified from a cohort recruited from the North West of England referred for a bone densitometry (DEXA) scan and receiving CS. Patients were divided into those that had sustained a fragility fracture (cases) and compared to those who had not (controls). Analysis was carried out using the student t-test for continuous variables and the Chi²test for categorical variables. Logistic regression analysis was carried out to investigate any significant association between BMD and bone fracture in patients receiving CS. HSA variables were also included in the model.

Results

There were 3,360 patients (73.46% female) identified as receiving CS, of which 779 (23.18%) had suffered from a facture. Mean age of patients who suffered a fracture was significantly higher than those who did not; 62.33 (SD=13.09) vs 67.39 (SD=11.75) respectivly (p value = <0.001). Females were significantly more likely to suffer a fracture compare to males; 33.86% vs 20.00% respectively (p.value=<0.001). After adjusting for age and sex, the mean difference in BMD between patients on steroids who suffered a facture compared to those who did not suffer a fracture at the femoral neck was 0.06 g/cm2 (95%CI=0.05-0.08) and at the lumbar spine was 0.09 g/cm2 (95%CI=0.07-0.10). Logistic regression analysis after adjustment showed that patients who were on steroids were likely to have a lower BMD at the femoral neck (OR=0.13, 95%CI=0.06-0.34) and the lumbar spine (OR=0.13, 95%CI=0.08-0.21). Modelling HSA showed that after adjustment, Cross sectional moment of inertia and not hip axis length was different between the cohorts (OR 0.95 95%CI 0.95,0.98 vs OR 0.99 95%CI 0.98,1.01 respectively).

Conclusion

In this cohort of patients fractures in those taking steroids are associated with increasing age, female sex, and lower BMD. Patients who are taking CS and suffer from a fracture are significantly more likely to have a lower BMD. Differences in Hip structure are also seen. This study does not support the theory that CS are an independent variable in fracture risk in patients. Further prospective studies are needed.

Disclosure:

J. Heath,
None;

A. Oldroyd,
None;

M. Boers,
None;

M. Bukhari,
None.

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