Rheumatology ·
Fragility fractures common in glucocorticoid-treated rheumatic disease cohort
A cross-sectional medical-records study of 223 patients with rheumatic diseases receiving glucocorticoids found reduced bone mineral density in 83.6% of those with available DXA classification. Fragility fractures were reported in 38.1% of patients, and most patients with fractures did not have densitometric osteoporosis.
- Reduced BMD was present in 83.6% of classified patients.
- Fragility fractures occurred in 38.1% of the cohort.
- Most fracture patients did not have densitometric osteoporosis.
- Age, female sex and disease duration were associated with fractures.
Researchers reviewed medical records for 223 patients with rheumatic diseases receiving glucocorticoid therapy who underwent osteoporosis screening. The study assessed DXA results, glucocorticoid exposure and fragility fractures; 93.3% of participants were female, mean age was 59.9 years, and rheumatoid arthritis was the most common diagnosis. DXA classification was available for 214 patients.
Of those 214 patients, 55.6% had osteopenia and 28.0% had osteoporosis, while 16.4% had normal bone mineral density. Fragility fractures occurred in 38.1% of the cohort. Among patients with fractures and available DXA classification, 67.9% had normal BMD or osteopenia rather than densitometric osteoporosis. Older age, female sex and longer disease duration were independently associated with fractures; the reported odds ratios were 1.22 per year, 10.40 and 1.07 per year, respectively.
The findings suggest DXA-defined osteoporosis alone may not capture fracture burden in glucocorticoid-treated patients with rheumatic disease. However, this was a cross-sectional review of patients who had undergone screening, so it cannot establish causality or determine how risk assessment should be changed. The results support consideration of clinical factors alongside BMD, but do not evaluate a specific screening or prevention strategy.
In practice
For patients with rheumatic diseases receiving glucocorticoids, this cohort found that fragility fractures were common and often occurred without densitometric osteoporosis: 67.9% of fracture patients with available DXA had normal BMD or osteopenia. This supports the concern that BMD alone may not reflect fracture burden in this population. The evidence is cross-sectional and based on screened patients, so it does not establish causation or validate a specific alternative assessment strategy; it is not sufficient by itself to change management.
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Clinical Rheumatology: Glucocorticoid-induced osteoporosis in patients with rheumatic diseases: clinical characteristics, associated factors, and fragility fractures ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.