Background/Purpose: Polymyalgia Rheumatica (PMR) and Giant Cell Arteritis (GCA) are systemic inflammatory disorders treated with prolonged corticosteroid therapy. Prolonged use of corticosteroids is a significant risk factor for developing osteoporosis and subsequent fractures. In adults over 40, osteoporosis is defined as the presence of a fragility fracture or a T-score < -2.5, or a high fracture risk as defined by FRAX scoring of >20% for a major osteoporotic fracture or >3% for a hip fracture. It is also suggested to increase the FRAX estimates for hip fracture and overall fracture by 20% and 15%, respectively, for patients on doses > 7.5 mg/d prednisone for at least three months. If the FRAX score is not considered or corrected for glucocorticoid exposure, this may lead to the underdiagnosis of osteoporosis. This study aimed to explore this risk by reanalyzing the FRAX scores of an osteopenic cohort of Polymyalgia Rheumatica (PMR) patients and comparing them to their original classification.

Methods: We conducted a retrospective review of PMR patients at a rheumatology clinic, focusing on those diagnosed with PMR or PMR with GCA and excluding patients with other rheumatological disorders. The study included 459 patients from 2011 to 2021. We retrospectively assessed the osteopenic patients and calculated each patient’s FRAX with glucocorticoid correction, if applicable

Results: The original study included 459 PMR patients, with documentation showing that 171 (37.2%) had osteoporosis, 70 (15.3%) had osteopenia, 121 (26.4%) had normal bone mineral density, and 98 (21.4%) had no available DXA data. In the original cohort, screening for osteoporosis using DXA scans was conducted for 64.4% of patients. Among the total PMR patients, 37.3% were diagnosed with osteoporosis, and 16% had osteopenia. In the present analysis, after considering FRAX scoring and glucocorticoid correction, 41.4% of the documented osteopenic patients were found to qualify for osteoporosis diagnosis, increasing the total osteoporotic subset of our PMR cohort to 200 (43.6%).

Conclusion: The FRAX calculation and glucocorticoid correction should be included in the osteoporosis diagnosis rather than relying solely on the T score; otherwise, osteopenic patients may inadvertently remain untreated.

« Back to ACR Convergence 2025

ACR Meeting Abstracts - https://acrabstracts.org/abstract/underrecognized-glucocorticoid-induced-osteoporosis-in-a-polymyalgia-rheumatica-patient-cohort/