Session Title: Vasculitis
Session Type: Abstract Submissions (ACR)
Giant cell arteritis (GCA) is a common form of vasculitis mainly affecting individuals older than 50 years with a mean onset age of 69 years. The prevalence of osteoporosis in postmenopausal women is high and increases with age. The recommended standard treatment for GCA is high doses of glucocorticosteroids which over weeks are reduced to lower maintenance doses. The aim of this study was to examine the prevalence of reduced bone mineral density (BMD) in patients with a new onset GCA and to examine if these patients were treated adequately according to the American College of Rheumatology (ACR) 2010 recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis.
Patients diagnosed at our outpatient clinic with GCA from January 2010 to May 2012 were retrospectively assessed. The majority of patients were examined by dual energy X-ray absorptiometry (DXA) in spine and hips. The WHO definition was applied to define osteoporosis (T-score≤– 2.5 SD at femoral neck and / or lumbar spine L1-4) and osteopenia (T-score <-1 and >-2.5 SD). Treatment data were also recorded.
A total of 36 patients were diagnosed with GCA (27 females, 9 males). Two patients were excluded due to known osteoporosis. From the 34 remaining patients (25 females and 9 males) DXA measurement was performed in 27 (23 females and 4 males) patients at the time of the initial evaluation. A total of 21 patients (78%) had reduced BMD (osteoporosis in 13 females and osteopenia in 3 males and 5 females). Treatment with bisphosphonates was initiated in 14 out the 21 patients (67%) with reduced BMD (11 patients with osteoporosis and 3 patients with osteopenia) who according to the ACR guidelines were recommended treatment. All patients with osteoporosis and osteopenia received calcium and vitamin D supplementation.
More than 75% of the DXA examined patients had reduced BMD and thus were in need for osteoporosis treatment with bisphosphonates according to the ACR 2010 recommendations for glucocorticoid-induced osteoporosis. Despite the clear guidelines 1 out of 3 GCA patients were in our patient cohort not treated properly. Our data emphasizes the need for increased awareness of osteoporosis and osteopenia in these patients which are at high risk for future fractures.
A. P. Diamantopoulos,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-prevalence-of-low-bone-mineral-density-in-patients-with-new-onset-giant-cell-arteritis-do-they-get-appropriate-bone-protective-treatment/