Department of Clinical Pharmacy, Curaçao Medical Centre, Willemstad, Curaçao.
Department of Clinical Pharmacy, Maastricht University Medical Centre, Maastricht, The Netherlands.
Osteoporos Int. 2022 Mar;33(3):649-658. doi: 10.1007/s00198-021-06101-3. Epub 2021 Oct 3.
Oral glucocorticoids may increase major osteoporotic fracture risk (MOF) in myasthenia gravis patients. To assess this risk, we performed a case-control study including all Danish patients with a MOF between 1995 and 2011. We also pooled our data with data from another study. We found no increased risk. Osteoporosis prevention remains advisable.
PURPOSE/INTRODUCTION: The prolonged use of high doses of oral glucocorticoids (GCs), a common treatment in patients with myasthenia gravis (MG), may increase major osteoporotic fracture (MOF) risk. Previous epidemiological studies did not exclusively focus on patients with MG or had relatively few GC-exposed MG patients. Aims were to evaluate the risk of MOF in MG patients using oral GCs in a large study population and to perform a pooled analysis with data from previous work.
A population-based case-control study (1995-2011) was conducted using the Danish National Health Service. Cases had sustained a MOF, and controls had not. All were aged ≥ 18 years. Multivariate conditional logistic regression estimated odds ratios (ORs) among MG patients using oral GCs versus non-users. Adjustments were made for comorbidities and comedications. In the pooled analysis, results were pooled by the use of generic inverse variance methods, assuming a random-effects model.
We identified 376,858 cases and 376,858 controls. MOF risk was not elevated in MG patients currently using oral GCs compared to MG patients not on oral GCs (OR: 1.26 (95% CI 0.68-2.33)). The use of the highest cumulative dose of oral GCs (≥ 7 g) did not show an increased risk of MOF among MG patients (OR: 2.00 (95% CI 0.90-4.44)). Our pooled analysis also showed no association between oral GC use and MOF risk.
This study showed that oral GC use in patients with MG was not associated with increased risk of MOF in our case-control study and pooled analysis. Osteoporosis prevention in MG patients based on clinical guidelines remains advisable.
目的/引言：口服糖皮质激素（GCs）的长期大剂量应用是重症肌无力（MG）患者的常见治疗方法，可能会增加主要骨质疏松性骨折（MOF）的风险。先前的流行病学研究并未专门针对 MG 患者进行研究，或者 GC 暴露的 MG 患者数量相对较少。本研究旨在评估 MG 患者使用口服 GCs 后的 MOF 风险，并进行一项包含先前研究数据的汇总分析。
本研究采用基于人群的病例对照研究（1995-2011 年），使用丹麦国家卫生服务系统进行。病例组为发生 MOF 的患者，对照组则未发生 MOF。所有患者年龄均≥18 岁。多变量条件逻辑回归用于评估 MG 患者使用口服 GCs 与未使用口服 GCs 患者之间的比值比（OR）。调整了合并症和合并用药的影响。在汇总分析中，采用通用倒数方差法进行汇总，并假设使用随机效应模型。
共纳入 376858 例病例和 376858 例对照。与未使用口服 GCs 的 MG 患者相比，目前正在使用口服 GCs 的 MG 患者的 MOF 风险并未升高（OR：1.26（95%CI 0.68-2.33））。使用最高累积剂量口服 GCs（≥7g）并未显示出 MG 患者 MOF 风险增加（OR：2.00（95%CI 0.90-4.44））。我们的汇总分析也显示，口服 GC 应用与 MOF 风险之间无关联。
本研究表明，在我们的病例对照研究和汇总分析中，MG 患者使用口服 GCs 与 MOF 风险增加无关。基于临床指南，MG 患者进行骨质疏松症预防仍然是合理的。
