Bone mineral density in patients diagnosed with giant cell arteritis taking glucocorticoids: a case-control study
Adam Geressu1, Zain Sultan1, Marwan Bukhari2
1University Hospitals of Morecambe Bay NHS Foundation Trust, Royal Lancaster Infirmary, Lancaster, UK.
Insights
Glucocorticoids (GCs) used to treat Giant Cell Arteritis (GCA) significantly reduce bone mineral density (BMD) at the hip and femoral neck. This study highlights the hip as particularly vulnerable to GC-induced bone loss in GCA patients.
Area of Science:
- Rheumatology
- Endocrinology
- Bone Metabolism
Background:
- Giant Cell Arteritis (GCA) is a systemic vasculitis typically treated with high-dose glucocorticoids (GCs).
- The impact of GCs on bone mineral density (BMD) at different skeletal sites in GCA patients remains unclear.
- Understanding site-specific BMD changes is crucial for managing long-term GC toxicity.
Purpose of the Study:
- To investigate the differential effects of GCs on BMD at the lumbar spine versus the hip in patients with GCA.
- To compare BMD in GCA patients on GC therapy with a control group matched for age and sex.
Main Methods:
- A case-control study design was employed, including patients referred for DXA scans between 2010-2019.
- Cases were GCA patients on current GC treatment, matched 1:4 to controls with no indication for scanning.
- Logistic regression models analyzed BMD at the spine and hip, adjusted for height and weight.
Main Results:
- Significantly lower adjusted odds ratios for BMD were observed in GCA patients on GCs.
- Specific findings included ORs of 0.187 (right femoral neck), 0.005 (left total hip), and 0.003 (right total hip).
- No significant difference was found at the lumbar spine (OR 0.280) or left femoral neck (OR 0.238).
Conclusions:
- GC treatment in GCA patients is associated with reduced BMD at the right femoral neck and both left and right total hip.
- The hip appears more susceptible to GC-induced bone loss than the lumbar spine in this patient cohort.
- These findings underscore the importance of monitoring hip BMD in GCA patients undergoing GC therapy.
Objective:
The standard treatment for GCA is high-dose glucocorticoids (GCs). It is unknown whether GCs are more detrimental to BMD at the spine or the hip. The aim of this study was to investigate the effect of GCs on BMD at the lumbar spine and hip in patients with GCA being treated with GCs.
Methods:
Patients who were referred for DXA at a hospital in the north-west of England between 2010 and 2019 were included. Two patient groups were identified: patients with GCA on current GC (cases) were matched 1:4 based on age and biological sex to those referred to the scanner with no indication for scanning (controls). Logistic models were fitted looking at the spine and hip BMD, unadjusted and adjusted for height and weight.
Results:
As would be expected, this gave an adjusted odds ratio (OR) of 0.280 (95% CI 0.071, 1.110) at the lumbar spine, OR of 0.238 (95% CI 0.033, 1.719) at the left femoral neck, OR of 0.187 (95% CI 0.037, 0.948) at the right femoral neck, OR of 0.005 (95% CI 0.001, 0.021) at the left total hip and OR of 0.003 (95% CI 0.001, 0.015) at the right total hip.
Conclusion:
The study has shown that patients diagnosed with GCA receiving GC treatment have a lower BMD at the right femoral neck, left total hip and right total hip compared with controls in patients of the same age and biological sex after adjusting for height and weight.
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