Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.
Arthritis Res Ther. 2023 Jun 7;25(1):98. doi: 10.1186/s13075-023-03083-x.
It is unclear whether sex or age modify the association of glucocorticoid (GC) use with reduced bone mineral density (BMD) in patients with rheumatoid arthritis (RA).
We studied cross-sectional data of RA patients with current or previous GC treatment in a single center cohort study (Rh-GIOP cohort). Our primary outcome was the minimum T-score (measured by DXA) of either lumbar spine, total femur, or femoral neck. Current GC dose was the main exposure; cumulative GC dose and cumulative duration of GC use were also assessed. Following a predefined statistical analysis plan, linear regression analyses with adjustment for confounders assessed whether the association of GC use with BMD was modified by sex (men versus women) or age (≥ 65 versus < 65 years).
Four hundred eighty-three patients with RA (mean age 64 ± 12 years, 80% women) were included. 33% were not currently taking GCs, 32% were treated with a dose of 5 mg/d prednisone equivalent and 11% with more than 7.5 mg/d. 23% of patients had osteoporosis by DXA (minimum T-score ≤ -2.5). The slope, i.e., the association between changes in minimum T-scores with 1 mg/d change in current GC dose, was similar in men and women (-0.07 and -0.04, respectively; difference -0.03 [-0.11 to 0.04]; p for interaction = 0.41). Slopes were also similar for elderly and non-elderly patients (-0.03 and -0.04, respectively; difference -0.01 [-0.06 to 0.05]; p for interaction = 0.77). Using cumulative dose and duration of use as exposures did not lead to substantial changes of these results.
In our sample, the association of GC use with reduced BMD in RA was not modified by sex or age.
糖皮质激素（GC）使用与类风湿关节炎（RA）患者骨密度（BMD）降低之间的关联是否受性别或年龄影响尚不清楚。
我们在单中心队列研究（Rh-GIOP 队列）中研究了当前或既往接受 GC 治疗的 RA 患者的横断面数据。我们的主要结局是腰椎、全股骨或股骨颈的最小 T 评分（通过 DXA 测量）。当前 GC 剂量是主要暴露因素；还评估了累积 GC 剂量和 GC 使用时间的累积时长。根据预先设定的统计分析计划，调整混杂因素的线性回归分析评估了 GC 使用与 BMD 之间的关联是否受性别（男性与女性）或年龄（≥65 岁与<65 岁）影响。
共纳入 483 例 RA 患者（平均年龄 64±12 岁，80%为女性）。33%的患者目前未服用 GC，32%的患者服用 5mg/d 泼尼松等效剂量，11%的患者服用剂量超过 7.5mg/d。23%的患者通过 DXA 检查患有骨质疏松症（最小 T 评分≤-2.5）。男性和女性之间，当前 GC 剂量每增加 1mg/d 时，最小 T 评分变化的斜率（即变化的关联）相似（分别为-0.07 和-0.04；差异-0.03[-0.11 至 0.04]；p 交互作用=0.41）。老年和非老年患者的斜率也相似（分别为-0.03 和-0.04；差异-0.01[-0.06 至 0.05]；p 交互作用=0.77）。使用累积剂量和使用时间作为暴露因素并没有导致这些结果发生实质性变化。
在我们的样本中，GC 使用与 RA 患者 BMD 降低之间的关联不受性别或年龄影响。
