Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany.
Department of Rheumatology and Immunology, Medical University Graz, 8036 Graz, Austria.
Cells. 2022 Feb 4;11(3):536. doi: 10.3390/cells11030536.
Glucocorticoids (GCs) can cause osteoporosis (OP). Prior observational research on bone density and the effects of GCs in polymyalgia rheumatica (PMR) and vasculitides is scarce and inconclusive.
Rh-GIOP is a prospective cohort study of bone health in patients with inflammatory rheumatic diseases. In this cross-sectional baseline analysis, we focused on patients with PMR and different forms of vasculitides. Multivariable linear regression was used to model the effect of current and cumulative GC intake on the minimum T-score at any site (mTs; at either lumbar spine or hip), with comprehensive adjustment for confounders. In separate models, GCs were modelled both as continuous and categorical predictors. Sensitivity analyses, stratifying by measurement site and disease, were conducted.
A total of 198 patients, with a mean age of 67.7 ± 11.4 years and a mean disease duration of 5.3 ± 6.3 years, were included. Most patients suffered from PMR (36%), giant cell arteritis (26%) or granulomatosis with polyangiitis (17%). Women comprised 66.7% of the patients, and 87.4% were currently taking GCs. The mean CRP was 13.2 ± 26.1 mg/L. OP diagnosed by dual energy X-ray absorptiometry (DXA) (T-score ≤ -2.5) was present in 19.7% of the patients. While 88% were taking vitamin D supplements, calcium supplementation (4%) and treatment with anti-resorptive agents (17%) were relatively infrequent. Only 7% had a vitamin D deficit. Neither current ((continuous model) = -0.01, 97.5% CI -0.02 to 0.01; (all models) ≥ 0.49) nor cumulative ((continuous model) = 0.01, 97.5% CI -0.04 to 0.07; (all models) ≥ 0.35) GC doses were associated with mTs in any model. CRP was not associated with mTs in any model ((all models) ≥ 0.56), and no interaction between CRP and GC intake was observed ( for interaction(all models) ≥ 0.32). Across all analyses, lower body mass index ((all models) ≤ 0.01), history of vertebral fractures ((all models) ≤ 0.02) and proton-pump inhibitor intake ((all models) ≤ 0.04) were associated with bone loss. Sensitivity analyses with femoral neck and lumbar spine T-scores as dependent variables led to similar results as the analysis that excluded patients with PMR.
In this cohort of PMR and vasculitides, we found a similar prevalence of OP by DXA to the overall elderly German population. Vitamin D supplementation was very common, and vitamin D insufficiency was less frequent than expected in Germans. There was no association between current or cumulative GC intake, CRP and impaired bone density. Proton-pump inhibitors seem to be a major, but somewhat neglected, risk factor for OP and should be given more attention. Our findings require confirmation from longitudinal analyses of the Rh-GIOP and other cohorts.
糖皮质激素（GCs）可导致骨质疏松症（OP）。先前关于巨细胞动脉炎（PMR）和血管炎患者骨密度和 GCs 作用的观察性研究很少且结论不一致。
Rh-GIOP 是一项针对炎症性风湿性疾病患者骨骼健康的前瞻性队列研究。在这项横断面基线分析中，我们专注于患有 PMR 和不同形式血管炎的患者。使用多变量线性回归模型来模拟当前和累积 GC 摄入量对任何部位（腰椎或髋部）最小 T 评分（mTs）的影响，全面调整混杂因素。在单独的模型中，GC 被建模为连续和分类预测因子。进行了以测量部位和疾病为分层的敏感性分析。
共纳入 198 名患者，平均年龄为 67.7 ± 11.4 岁，平均病程为 5.3 ± 6.3 年。大多数患者患有 PMR（36%）、巨细胞动脉炎（26%）或肉芽肿性多血管炎（17%）。女性占患者的 66.7%，87.4%的患者目前正在服用 GCs。平均 CRP 为 13.2 ± 26.1mg/L。通过双能 X 线吸收法（DXA）诊断的 OP（T 评分≤-2.5）在 19.7%的患者中存在。尽管 88%的患者服用维生素 D 补充剂，但钙补充剂（4%）和抗吸收剂治疗（17%）相对较少。只有 7%的患者存在维生素 D 缺乏症。当前（连续模型）= -0.01，97.5%CI -0.02 至 0.01；（所有模型）≥0.49）或累积（连续模型）= 0.01，97.5%CI -0.04 至 0.07；（所有模型）≥0.35）GC 剂量在任何模型中均与 mTs 无关。CRP 在任何模型中均与 mTs 无关（所有模型）≥0.56），并且未观察到 CRP 和 GC 摄入之间的交互作用（所有模型）≥0.32）。在所有分析中，较低的体重指数（所有模型）≤0.01）、椎体骨折史（所有模型）≤0.02）和质子泵抑制剂摄入（所有模型）≤0.04）与骨丢失有关。以股骨颈和腰椎 T 评分为因变量的敏感性分析得出了与排除 PMR 患者的分析类似的结果。
在这项 PMR 和血管炎的队列研究中，我们通过 DXA 发现了与德国老年人群相似的 OP 患病率。维生素 D 补充剂非常普遍，维生素 D 不足的情况比预期在德国更为少见。当前或累积 GC 摄入、CRP 与骨密度受损之间无关联。质子泵抑制剂似乎是 OP 的一个主要但有些被忽视的危险因素，应给予更多关注。我们的发现需要通过 Rh-GIOP 和其他队列的纵向分析来证实。
