Low-Dose Steroids for RMD Not Associated With Reduced Bone Density

Daily glucocorticoid doses of 5 mg or less did not appear to be linked with reduced bone mineral density in patients with inflammatory rheumatic and musculoskeletal diseases and current or prior exposure to glucocorticoids, according to study findings published online ahead of print in the Annals of the Rheumatic Diseases.

“This is most likely due to the dampening of inflammation by glucocorticoids, which exerts a mitigating effect on the risk of osteoporosis,” wrote an international team of researchers.

The results stemmed from an analysis of baseline data for 1066 participants in a prospective observational cohort study (Rh-GIOP), which is investigating bone health in consecutive patients with inflammatory rheumatic and musculoskeletal disease and current or prior glucocorticoid treatment.

Neither daily glucocorticoid dose of less than 5 mg of prednisone equivalent, nor cumulative dose, nor duration of glucocorticoid therapy, was associated with negative effects on bone mineral density as measured by dual X-ray absorptiometry, the study found.

“Dosages of ≥5 mg/day lost their negative association with bone mineral density after adjustment for confounders,” researchers reported. A subanalysis focusing only on patients with daily glucocorticoid doses of exactly 5 mg found no negative effect on bone mineral density.

In patients with rheumatoid arthritis, current daily glucocorticoid doses above 7.5 mg showed a negative association with bone mineral density overall, according to the analysis. However, the effect appeared exclusive to patients with moderate to high disease activity.

—Jolynn Tumolo

Reference:

Wiebe E, Huscher D, Schaumburg D, et al. Optimising both disease control and glucocorticoid dosing is essential for bone protection in patients with rheumatic disease. Ann Rheum Dis. Published online ahead of print June 9, 2022. http://dx.doi.org/10.1136/annrheumdis-2022-222339