Rossini M, Viapiana O, Vitiello M, Malavolta N, La Montagna G, Maddali Bongi S, Di Munno O, Nuti R, Manzini C U, Ferri C, Bogliolo L, Mathieu A, Cantatore F, Del Puente A, Muratore M, Grassi W, Frediani B, Saviola G, Delvino P, Mirone L, Ferraccioli G, Tripi G, Piazza I, Gatti D
Osteoporosis and Metabolic Skeletal Diseases Study Group of Italian Society of Rheumatology (SIR).
Reumatismo. 2017 May 22;69(1):30-39. doi: 10.4081/reumatismo.2017.922.
Osteoporosis and fractures are common and invalidating consequences of chronic glucorticoid (GC) treatment. Reliable information regarding the epidemiology of GC induced osteoporosis (GIOP) comes exclusively from the placebo group of randomized clinical trials while observational studies are generally lacking data on the real prevalence of vertebral fractures, GC dosage and primary diagnosis. The objective of this study was to evaluate the prevalence and incidence of osteoporotic fractures and to identify their major determinants (primary disease, GC dosage, bone mineral density, risk factors, specific treatment for GIOP) in a large cohort of consecutive patients aged >21 years, on chronic treatment with GC (≥5 mg prednisone - PN - equivalent) and attending rheumatology centers located all over Italy. Glucocorticoid Induced OsTeoporosis TOol (GIOTTO) is a national multicenter cross-sectional and longitudinal observational study. 553 patients suffering from Rheumatoid Arthritis (RA), Polymyalgia Rheumatica (PMR) and Connective Tissue Diseases (CTDs) and in chronic treatment with GCs were enrolled. Osteoporotic BMD values (T score <-2.5) were observed in 28%, 38% and 35% of patients with CTDs, PMR or RA at the lumbar spine, and in 18%, 29% and 26% at the femoral neck, respectively. Before GC treatment, prevalent clinical fractures were reported by 12%, 37% and 17% of patients with CTDs, PMR, or RA, respectively. New clinical fragility fractures during GC treatment were reported by 12%, 10% and 23% of CTDs, PMR and RA patients, respectively. Vertebral fractures were the prevailing type of fragility fracture. More than 30% of patients had recurrence of fracture. An average of 80% of patients were in supplementation with calcium and/or vitamin D during treatment with GCs. Respectively, 64%, 80%, and 72% of the CTDs, PMR and RA patients were on pharmacological treatment for GIOP, almost exclusively with bisphosphonates. The GIOTTO study might provide relevant contributions to clinical practice, in particular by highlighting and quantifying in real life the prevalence of GIOP and relative fractures, the frequency of the main risk factors, and the currently sub-optimal prevention. Moreover, these results emphasize the importance of the underlying rheumatic disease on the risk of GIOP associated fractures.
骨质疏松症和骨折是慢性糖皮质激素（GC）治疗常见且会导致功能丧失的后果。关于糖皮质激素诱导的骨质疏松症（GIOP）流行病学的可靠信息仅来自随机临床试验的安慰剂组，而观察性研究通常缺乏椎体骨折的实际患病率、GC剂量和初始诊断的数据。本研究的目的是评估骨质疏松性骨折的患病率和发病率，并确定其主要决定因素（原发性疾病、GC剂量、骨密度、危险因素、GIOP的特异性治疗），研究对象为一大群年龄>21岁、接受GC（≥5mg泼尼松等效剂量）长期治疗且就诊于意大利各地风湿病中心的连续患者。糖皮质激素诱导骨质疏松症工具（GIOTTO）研究是一项全国性多中心横断面和纵向观察性研究。纳入了553例患有类风湿关节炎（RA）、风湿性多肌痛（PMR）和结缔组织病（CTD）且正在接受GC长期治疗的患者。患有CTD、PMR或RA的患者中，分别有28%、38%和35%在腰椎处骨密度值为骨质疏松（T值<-2.5），在股骨颈处该比例分别为18%、29%和26%。在GC治疗前，患有CTD、PMR或RA的患者中，分别有12%、37%和17%报告有临床骨折史。在GC治疗期间，CTD、PMR和RA患者中分别有12%、10%和23%报告发生了新的临床脆性骨折。椎体骨折是脆性骨折的主要类型。超过30%的患者发生了骨折复发。在GC治疗期间，平均80%的患者补充了钙和/或维生素D。CTD、PMR和RA患者中，分别有64%、80%和72%接受了GIOP的药物治疗，几乎均使用双膦酸盐。GIOTTO研究可能会对临床实践做出重要贡献，特别是通过在现实生活中突出并量化GIOP和相关骨折的患病率、主要危险因素的频率以及目前预防措施的欠佳情况。此外，这些结果强调了潜在风湿性疾病对GIOP相关骨折风险的重要性。
