Risk of Osteoporosis Associated with Glucocorticoid Use in Pemphigus Vulgaris: Insights from a Retrospective Cohort...

Pemphigus vulgaris (PV) is an autoimmune bullous disease affecting the skin and mucous membranes. Osteoporosis, a significant side effect of commonly used glucocorticoids in treatment, can adversely contribute to the existing morbidity.

This study aimed to assess the impact of glucocorticoid therapy on bone mineral density in patients with PV.

Patients newly diagnosed with PV were included in this study. Femur and lumbar T-scores, serum calcium, vitamin D, alkaline phosphatase (ALP), and lactate dehydrogenase (LDH) levels were analyzed before and one year after therapy.

Among 66 patients, the average time to diagnosis was 10.14 months, and the average daily dose of prednisone was 16.95 mg, with 63.6% of patients receiving medium doses. Our data showed no significant change in lumbar T-scores after one year of glucocorticoid treatment, but a significant decrease in femur density was observed. The decrease in femur T-scores was significant in the medium-dose group, while the lumbar T-scores decreased significantly in the high-dose group. There was no significant correlation between T-scores and sex, menopausal state, diagnosis time, or obesity. Additionally, vitamin D and LDH levels significantly increased after treatment, while changes in serum calcium and ALP levels were not significant.

Given the multiple factors that reduce bone mineral density in PV patients, the current strategies for glucocorticoid-induced osteoporosis prophylaxis in this group may need re-evaluation, with potential for additional recommendations to be included in pemphigus guidelines.