TY - JOUR
T1 - Sex and age do not modify the association between glucocorticoids and bone mineral density in patients with rheumatoid arthritis
T2 - a cross-sectional study
AU - Palmowski, Andriko
AU - Boyadzhieva, Zhivana
AU - Nielsen, Sabrina M.
AU - Muche, Burkhard
AU - Hermann, Sandra
AU - Boers, Maarten
AU - Bliddal, Henning
AU - Christensen, Robin
AU - Wiebe, Edgar
AU - Buttgereit, Frank
N1 - Funding Information: None. Publisher Copyright: © 2023, The Author(s).
PY - 2023/12/1
Y1 - 2023/12/1
N2 - 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.
AB - 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.
KW - Age
KW - Effect modifier
KW - Glucocorticoids
KW - Interaction
KW - Osteoporosis
KW - Prednisone
KW - Rheumatoid arthritis
KW - Sex
UR - http://www.scopus.com/inward/record.url?scp=85161121509&partnerID=8YFLogxK
U2 - https://doi.org/10.1186/s13075-023-03083-x
DO - https://doi.org/10.1186/s13075-023-03083-x
M3 - Article
C2 - 37287080
SN - 1478-6354
VL - 25
JO - Arthritis Research and Therapy
JF - Arthritis Research and Therapy
IS - 1
M1 - 98
ER -