Sex and age do not modify the association between glucocorticoids and bone mineral density in patients with rheumatoid arthritis: a cross-sectional study

Andriko Palmowski, Zhivana Boyadzhieva, Sabrina M. Nielsen, Burkhard Muche, Sandra Hermann, Maarten Boers, Henning Bliddal, Robin Christensen, Edgar Wiebe, Frank Buttgereit

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Abstract

Background: It is unclear whether sex or age modify the association of glucocorticoid (GC) use with reduced bone mineral density (BMD) in patients with rheumatoid arthritis (RA). Methods: We studied cross-sectional data of RA patients with current or previous GC treatment in a single center cohort study (Rh-GIOP cohort). Our primary outcome was the minimum T-score (measured by DXA) of either lumbar spine, total femur, or femoral neck. Current GC dose was the main exposure; cumulative GC dose and cumulative duration of GC use were also assessed. Following a predefined statistical analysis plan, linear regression analyses with adjustment for confounders assessed whether the association of GC use with BMD was modified by sex (men versus women) or age (≥ 65 versus < 65 years). Results: Four hundred eighty-three patients with RA (mean age 64 ± 12 years, 80% women) were included. 33% were not currently taking GCs, 32% were treated with a dose of 5 mg/d prednisone equivalent and 11% with more than 7.5 mg/d. 23% of patients had osteoporosis by DXA (minimum T-score ≤ -2.5). The slope, i.e., the association between changes in minimum T-scores with 1 mg/d change in current GC dose, was similar in men and women (-0.07 and -0.04, respectively; difference -0.03 [-0.11 to 0.04]; p for interaction = 0.41). Slopes were also similar for elderly and non-elderly patients (-0.03 and -0.04, respectively; difference -0.01 [-0.06 to 0.05]; p for interaction = 0.77). Using cumulative dose and duration of use as exposures did not lead to substantial changes of these results. Conclusions: In our sample, the association of GC use with reduced BMD in RA was not modified by sex or age.

Original languageEnglish
Article number98
JournalArthritis Research and Therapy
Volume25
Issue number1
DOIs
Publication statusPublished - 1 Dec 2023

Keywords

  • Age
  • Effect modifier
  • Glucocorticoids
  • Interaction
  • Osteoporosis
  • Prednisone
  • Rheumatoid arthritis
  • Sex

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