Background/Purpose: The standard treatment for Giant Cell Arteritis (GCA) is high dose glucocorticoid (GC). It is unknown whether steroids are more detrimental to the spine or the hip. The aim of this study was to examine bone mineral density (BMD) of the lumbar spine, left neck of femur, right neck of femur, left total hip and right total hip in patients diagnosed with GCA being treated with GC.

Methods: We collected data from patients with GCA who were referred to the rheumatology department at two hospitals in the North West of England between 2010 and 2019. Patient’s details recorded at time of scan included age, gender, Body Mass Index (BMI), and drug treatment, specifically GC use. Dual X-Ray absorptiometry (DEXA) assessed BMD in the spine (mean of L1-L4 vertebrae), left femoral neck, right femoral neck, left total hip and right total hip. Two patient groups were identified, patients with GCA on current GC (cases) and matched 1:4 to those referred for a DEXA scan with no reason for scanning (controls). The prevalence of BMD in each group was compared by a two sample t-test. A comparison was made between the two groups using logistic regression adjusting for age and gender.

Results: A total of 309 patients were included. 61 of these patients were diagnosed with GCA and had a DEXA scan performed (48 females, 13 males). In comparison the control group had 248 patients (196 females, 52 males). Patients diagnosed with GCA had higher values of BMD than patients not diagnosed with GCA that were of the same age and gender. This gave an odds ratio (OR) of 0.68(95%CI 0.18; 2.64) at the lumbar spine, OR of 2.05(95%CI 0.22; 19.45) at the left femoral neck, OR of 3.27(95%CI 0.33; 32.73) at the right femoral neck, OR of 4.26(95%CI 0.27; 66.52) at the left total hip and OR of 8.01(95%CI 0.43; 147.91) at the right total hip. The numeric values of BMD at all sites were higher in the patients with GCA than in the controls.

Conclusion: The study has shown a surprising protective effect GCA has on BMD. Patients diagnosed with GCA receiving GC treatment have shown to have a higher BMD compared to patients without GCA of the same age and gender. Possible confounders include length of time on steroid when scanned or unmeasured confounders in the controls.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/bone-mineral-density-in-patients-diagnosed-with-giant-cell-arteritis-taking-glucocorticoids-a-case-control-study/