Hansen Benjamin Bakke, Hass Rubin Katrine, Vind Nielsen Catharina, Frost Nielsen Morten, Hermann Anne Pernille, Abrahamsen Bo
OPEN-Open Patient Data Explorative Network, Odense University Hospital, Odense 5230, Denmark.
Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense 5230, Denmark.
J Clin Endocrinol Metab. 2025 Jul 15;110(8):e2570-e2582. doi: 10.1210/clinem/dgae832.
Glucocorticoids (GCs) are widely used for their anti-inflammatory and immunosuppressive properties. Their effect on bone health is predominantly negative by decreasing bone formation and increasing risk of fractures.
This work aimed to quantify the short- and long-term changes in total hip bone mineral density (THBMD) after initiating systemic GC treatment in previously GC treatment-naive adults without bone protective agents.
An observational study was conducted using THBMD data from dual-energy x-ray absorptiometry (DXA). Individuals were stratified by sex and tertiles of GC exposure. Individuals not GC-exposed served as a reference group. Routine-care DXA scans were obtained from the main public hospitals servicing the Island of Funen in Denmark. A total of 15 099 adults underwent routine DXA at Odense University Hospital between 2006 and 2021. Data were enriched with Danish national registers. Intervention included systemic GCs (observational data). The short-term outcome included annualized THBMD changes between first 2 DXA scans. The long-term outcome included greater than 5% annualized THBMD loss over a 10-year follow-up.
Strong associations between GC exposure and THBMD loss was found for both outcomes, with larger losses in the middle and upper tertiles of GC exposure. The risk of experiencing greater than 5% annualized THBMD loss was elevated, especially in the first 2 years of initiating GC treatment. There is significant heterogeneity in THBMD responses, with approximately 1 in 5 patients experiencing no nominal bone loss despite receiving upper tertile levels of GC exposure.
The findings confirm the association between initial GC exposure and significant bone loss. The heterogeneity in individual responses emphasizes the need for early monitoring and personalized approaches in managing bone health for patients undergoing GC treatment.
糖皮质激素（GCs）因其抗炎和免疫抑制特性而被广泛使用。它们对骨骼健康的影响主要是负面的，会减少骨形成并增加骨折风险。
本研究旨在量化在未使用骨保护剂且之前未接受过GC治疗的成年人中开始全身GC治疗后全髋关节骨密度（THBMD）的短期和长期变化。
使用双能X线吸收法（DXA）的THBMD数据进行一项观察性研究。个体按性别和GC暴露三分位数分层。未暴露于GC的个体作为参考组。常规护理DXA扫描来自丹麦菲英岛的主要公立医院。2006年至2021年期间，共有15099名成年人在欧登塞大学医院接受了常规DXA检查。数据通过丹麦国家登记册得到补充。干预措施包括全身GC（观察性数据）。短期结果包括前两次DXA扫描之间的THBMD年化变化。长期结果包括在10年随访期间年化THBMD损失超过5%。
两种结果均发现GC暴露与THBMD损失之间存在强关联，GC暴露中三分位数和上三分位数的损失更大。经历年化THBMD损失超过5%的风险升高，尤其是在开始GC治疗的头两年。THBMD反应存在显著异质性，约五分之一的患者尽管接受了上三分位数水平的GC暴露，但未出现明显的骨质流失。
研究结果证实了初始GC暴露与显著骨质流失之间的关联。个体反应的异质性强调了对接受GC治疗的患者进行早期监测和个性化管理骨骼健康方法的必要性。
