Patients Taking Glucocorticoids More Likely to Develop Vertebral Fractures

Widely prescribed glucocorticoids are used to treat a variety of conditions, including inflammatory arthritis. However, these medications can result in weakening of the bones.  

In a study presented as a poster abstract at the recent World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases in Milan, Italy (March 26-29, 2015), lead author Jelena Zvekić-Svorcan, MD, MSc, Special Hospital for Rheumatic Diseases, University of Novi Sad, Serbia, and colleagues examined the effects of glucocorticoids on bone mineral density (BMD) and on the incidence of vertebral
osteoporotic fractures.

“The main motivation for this study is the fact that glucocorticoids are the predictors for osteoporosis (glucocorticoid-induced osteoporosis), which increases the risk for fracture occurrence,” said Zvekić-Svorcan in an e-mail to Annals of Long-Term Care: Clinical Care and Aging. “We analyzed occurrence of vertebral fractures, knowing that osteoporotic fractures mostly occur in bones where trabecular bone tissue prevails, such as vertebrae. Only one-third of vertebral fractures are recognized in clinical practice, so this is a major health, social, and economic issue. Also, vertebral fractures are linked to increased risk of future fractures—both vertebral and nonvertebral.”

Researchers used data from the National Register for Osteoporosis in Serbia for this retrospective analysis. A total of 217 menopausal women with osteoporosis (average age, 70 years) were included in the study. Groups 1 and 2 consisted of individuals with vertebral fractures (n=110) and those without vertebral fractures (n=107; control group), respectively.

Zvekić-Svorcan and colleagues assessed the effect of glucocorticoids as a risk factor for lower BMD and the occurrence of vertebral fractures, using the F-test, Fisher’s exact test, and multiple regression analyses in their statistical analysis.

Individuals from Groups 1 and 2 who were taking glucocorticoids, which comprised 27.2% of the study population, had significantly lower BMD compared with those who were not taking glucocorticoids (t=5.174; P<.01). Furthermore, the researchers found that the risk of vertebral fracture was 87-times higher for individuals who were taking glucocorticoids (odds ratio, 87.618; 95% confidence interval, 9.175–838.707); this was the most important result of the study, according to Zvekić-Svorcan. The Fisher’s exact test revealed that significantly more patients with vertebral fractures took glucocorticoids than patients without vertebral fractures (43.6% vs 10.3%; P<.01).

“Our results were similar to those of other studies in this field,” Zvekić-Svorcan noted.
The authors concluded that glucocorticoid use is a major predictor for the occurrence of vertebral osteoporotic fractures.

“Therefore, in patients with GIOP [glucocorticoid-induced osteoporosis], constant monitoring is needed, with preventive measures, removal of other risk factors, vitamin D and calcium supplements, and of course, adequate therapy,” the authors concluded in their poster.—Meredith Edwards White

References:

Amin S. Glucocorticoid-induced osteoporosis. https://www.rheumatology.org/Practice/Clinical/Patients/Diseases_And_Conditions/Glucocorticoid-Induced_Osteoporosis/. Accessed May 5, 2015.