One-year effects of glucocorticoids on bone density: a meta-analysis in cohorts on high and low-dose therapy
BACKGROUND: Bone loss during glucocorticoid (GC) therapy is poorly quantified. OBJECTIVE: Quantification of bone loss in GC-treated patients with chronic inflammatory diseases (CID; low dose) and transplants (high dose). METHODS: Meta-analysis of cohorts: PubMed, Cochrane, EMBASE and bibliographic s...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2016
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5020666/ https://www.ncbi.nlm.nih.gov/pubmed/27651928 http://dx.doi.org/10.1136/rmdopen-2016-000313 |
_version_ | 1782453247038980096 |
---|---|
author | Lems, Willem F Baak, Merel M E van Tuyl, Lilian H D Lodder, Mariëtte C Dijkmans, Ben A C Boers, Maarten |
author_facet | Lems, Willem F Baak, Merel M E van Tuyl, Lilian H D Lodder, Mariëtte C Dijkmans, Ben A C Boers, Maarten |
author_sort | Lems, Willem F |
collection | PubMed |
description | BACKGROUND: Bone loss during glucocorticoid (GC) therapy is poorly quantified. OBJECTIVE: Quantification of bone loss in GC-treated patients with chronic inflammatory diseases (CID; low dose) and transplants (high dose). METHODS: Meta-analysis of cohorts: PubMed, Cochrane, EMBASE and bibliographic searches (1995–2012). Eligible studies prospectively included GC-treated patients with two dual X-ray absorptiometry measurements of spine or hip over a period of at least 12 months. Only supplementation with calcium or vitamin D3 was allowed. 5602 titles yielded 285 articles: 51 study arms in CID (N=1565), 18 study arms in transplantation (N=571). Prednisone-equivalent GC doses and inverse variance weighted mean bone changes were used in a random effects model. RESULTS: In CID, the mean GC dose was 8.7 mg/day (range 1.2–16.4). The mean 1-year bone loss in the lumbar spine was −1.7% (95% CI –2.2% to –1.2%); in the femoral neck: –1.3 (–1.8 to –0.7). In transplantation, the mean GC dose was 18.9 mg/day (range 6.0–52.7). Bone loss in the lumbar spine was −3.6% (–5.2% to –2.0%); in the femoral neck: –3.1% (–5.1% to –1.1%). Within the two groups, bone loss was not related to GC dose. CONCLUSION: In CID, GC-related bone loss appears limited and manageable if current anti-osteoporotic strategies are fully implemented. In transplantation, and probably also other high-dose settings, bone loss is considerable and represents unmet need. The heterogeneity probably reflects the important influence of other factors, most notably the underlying disease and the efficacy of GC treatment. |
format | Online Article Text |
id | pubmed-5020666 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-50206662016-09-20 One-year effects of glucocorticoids on bone density: a meta-analysis in cohorts on high and low-dose therapy Lems, Willem F Baak, Merel M E van Tuyl, Lilian H D Lodder, Mariëtte C Dijkmans, Ben A C Boers, Maarten RMD Open Osteoporosis BACKGROUND: Bone loss during glucocorticoid (GC) therapy is poorly quantified. OBJECTIVE: Quantification of bone loss in GC-treated patients with chronic inflammatory diseases (CID; low dose) and transplants (high dose). METHODS: Meta-analysis of cohorts: PubMed, Cochrane, EMBASE and bibliographic searches (1995–2012). Eligible studies prospectively included GC-treated patients with two dual X-ray absorptiometry measurements of spine or hip over a period of at least 12 months. Only supplementation with calcium or vitamin D3 was allowed. 5602 titles yielded 285 articles: 51 study arms in CID (N=1565), 18 study arms in transplantation (N=571). Prednisone-equivalent GC doses and inverse variance weighted mean bone changes were used in a random effects model. RESULTS: In CID, the mean GC dose was 8.7 mg/day (range 1.2–16.4). The mean 1-year bone loss in the lumbar spine was −1.7% (95% CI –2.2% to –1.2%); in the femoral neck: –1.3 (–1.8 to –0.7). In transplantation, the mean GC dose was 18.9 mg/day (range 6.0–52.7). Bone loss in the lumbar spine was −3.6% (–5.2% to –2.0%); in the femoral neck: –3.1% (–5.1% to –1.1%). Within the two groups, bone loss was not related to GC dose. CONCLUSION: In CID, GC-related bone loss appears limited and manageable if current anti-osteoporotic strategies are fully implemented. In transplantation, and probably also other high-dose settings, bone loss is considerable and represents unmet need. The heterogeneity probably reflects the important influence of other factors, most notably the underlying disease and the efficacy of GC treatment. BMJ Publishing Group 2016-09-12 /pmc/articles/PMC5020666/ /pubmed/27651928 http://dx.doi.org/10.1136/rmdopen-2016-000313 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Osteoporosis Lems, Willem F Baak, Merel M E van Tuyl, Lilian H D Lodder, Mariëtte C Dijkmans, Ben A C Boers, Maarten One-year effects of glucocorticoids on bone density: a meta-analysis in cohorts on high and low-dose therapy |
title | One-year effects of glucocorticoids on bone density: a meta-analysis in cohorts on high and low-dose therapy |
title_full | One-year effects of glucocorticoids on bone density: a meta-analysis in cohorts on high and low-dose therapy |
title_fullStr | One-year effects of glucocorticoids on bone density: a meta-analysis in cohorts on high and low-dose therapy |
title_full_unstemmed | One-year effects of glucocorticoids on bone density: a meta-analysis in cohorts on high and low-dose therapy |
title_short | One-year effects of glucocorticoids on bone density: a meta-analysis in cohorts on high and low-dose therapy |
title_sort | one-year effects of glucocorticoids on bone density: a meta-analysis in cohorts on high and low-dose therapy |
topic | Osteoporosis |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5020666/ https://www.ncbi.nlm.nih.gov/pubmed/27651928 http://dx.doi.org/10.1136/rmdopen-2016-000313 |
work_keys_str_mv | AT lemswillemf oneyeareffectsofglucocorticoidsonbonedensityametaanalysisincohortsonhighandlowdosetherapy AT baakmerelme oneyeareffectsofglucocorticoidsonbonedensityametaanalysisincohortsonhighandlowdosetherapy AT vantuyllilianhd oneyeareffectsofglucocorticoidsonbonedensityametaanalysisincohortsonhighandlowdosetherapy AT loddermariettec oneyeareffectsofglucocorticoidsonbonedensityametaanalysisincohortsonhighandlowdosetherapy AT dijkmansbenac oneyeareffectsofglucocorticoidsonbonedensityametaanalysisincohortsonhighandlowdosetherapy AT boersmaarten oneyeareffectsofglucocorticoidsonbonedensityametaanalysisincohortsonhighandlowdosetherapy |