TY - JOUR
T1 - The effect of glucocorticoids on bone mineral density in patients with rheumatoid arthritis
T2 - A systematic review and meta-analysis of randomized, controlled trials
AU - Blavnsfeldt, Anne-Birgitte Garm
AU - de Thurah, Annette
AU - Thomsen, Malissa Dawn
AU - Tarp, Simon
AU - Langdahl, Bente
AU - Hauge, Ellen-Margrethe
PY - 2018/9
Y1 - 2018/9
N2 - Purpose: The role of glucocorticoids in the treatment of rheumatoid arthritis (RA) is widely debated. Impairment of bone formation may be counter-balanced by reduced systemic inflammation. This review aims to assess the effect of prednisolone/prednisone on bone mineral density (BMD) in patients with RA analyzed in randomized, controlled trials.Methods: We performed a systematic literature search and identified randomized, double-blinded placebo controlled studies including patients with RA and using prednisolone or prednisone as the intervention. We selected studies that measured BMD by DXA at baseline and at least once thereafter. Two authors independently performed reference review, data extraction and risk of bias assessment. Primary outcome was mean change in BMD from baseline to follow-up. Secondary endpoints included radiographic scores, RA disease activity indices and fractures. We rated the quality of evidence using the GRADE approach. Outcomes were standardized for meta-analyses and 95% confidence intervals (95% CI) were calculated.Results: We identified 7 studies and included previously unpublished data. Studies were similar regarding study population and intervention. Standard mean difference (SMD) in change in BMD from 0 to 24 months was 0.02 (95%CI 0.16, 0.12) at the lumbar spine and 0.11 (95% CI 0.25, 0.02) at the hip (both high quality evidence) between patients treated with prednisolone/prednisone or not. Data completeness was low in some studies, concomitant treatment of RA differed between studies and differences in use of anti-osteoporotic medication may have influenced the results. However, sensitivity analyses excluding studies in which participants used either the most or the least potent concomitant RA treatment or used anti-osteoporotic therapies did not alter the estimates.Conclusions: In patients with early and active RA, we found no difference in change in BMD between patients treated with prednisone/prednisolone versus placebo, suggesting that at least through 24 months, the suppression of inflammation by glucocorticoids may counterbalance their adverse effects on bone remodeling.
AB - Purpose: The role of glucocorticoids in the treatment of rheumatoid arthritis (RA) is widely debated. Impairment of bone formation may be counter-balanced by reduced systemic inflammation. This review aims to assess the effect of prednisolone/prednisone on bone mineral density (BMD) in patients with RA analyzed in randomized, controlled trials.Methods: We performed a systematic literature search and identified randomized, double-blinded placebo controlled studies including patients with RA and using prednisolone or prednisone as the intervention. We selected studies that measured BMD by DXA at baseline and at least once thereafter. Two authors independently performed reference review, data extraction and risk of bias assessment. Primary outcome was mean change in BMD from baseline to follow-up. Secondary endpoints included radiographic scores, RA disease activity indices and fractures. We rated the quality of evidence using the GRADE approach. Outcomes were standardized for meta-analyses and 95% confidence intervals (95% CI) were calculated.Results: We identified 7 studies and included previously unpublished data. Studies were similar regarding study population and intervention. Standard mean difference (SMD) in change in BMD from 0 to 24 months was 0.02 (95%CI 0.16, 0.12) at the lumbar spine and 0.11 (95% CI 0.25, 0.02) at the hip (both high quality evidence) between patients treated with prednisolone/prednisone or not. Data completeness was low in some studies, concomitant treatment of RA differed between studies and differences in use of anti-osteoporotic medication may have influenced the results. However, sensitivity analyses excluding studies in which participants used either the most or the least potent concomitant RA treatment or used anti-osteoporotic therapies did not alter the estimates.Conclusions: In patients with early and active RA, we found no difference in change in BMD between patients treated with prednisone/prednisolone versus placebo, suggesting that at least through 24 months, the suppression of inflammation by glucocorticoids may counterbalance their adverse effects on bone remodeling.
KW - Rheumatoid arthritis
KW - Osteoporosis
KW - Bone mineral density
KW - Glucocorticoids
KW - Meta-analysis
KW - LOW-DOSE PREDNISOLONE
KW - EULAR RECOMMENDATIONS
KW - DOUBLE-BLIND
KW - QUALITY
KW - OSTEOPOROSIS
KW - FRACTURE
KW - THERAPY
KW - WOMEN
KW - RISK
KW - INCONSISTENCY
UR - http://www.scopus.com/inward/record.url?scp=85048955039&partnerID=8YFLogxK
U2 - 10.1016/j.bone.2018.06.008
DO - 10.1016/j.bone.2018.06.008
M3 - Journal article
C2 - 29913256
SN - 8756-3282
VL - 114
SP - 172
EP - 180
JO - Bone
JF - Bone
ER -