Prevalence and incidence of osteoporotic fractures in sufferers on long-term glucocorticoid therapy for rheumatic illnesses: the Glucocorticoid Induced OsTeoporosis TOol (GIOTTO) research.
Reumatismo. 2017 Might 22;69(1):30-39
Authors: Rossini M, Viapiana O, Vitiello M, Malavolta N, La Montagna G, Maddali Bongi S, Di Munno O, Nuti R, Manzini CU, Ferri C, Bogliolo L, Mathieu A, Cantatore F, Del Puente A, Muratore M, Grassi W, Frediani B, Saviola G, Delvino P, Mirone L, Ferraccioli G, Tripi G, Piazza I, Gatti D
Osteoporosis and fractures are frequent and invalidating penalties of continual glucorticoid (GC) therapy. Dependable info concerning the epidemiology of GC induced osteoporosis (GIOP) comes solely from the placebo group of randomized medical trials whereas observational research are typically missing knowledge on the actual prevalence of vertebral fractures, GC dosage and first analysis. The target of this research was to guage the prevalence and incidence of osteoporotic fractures and to determine their main determinants (major illness, GC dosage, bone mineral density, danger elements, particular therapy for GIOP) in a big cohort of consecutive sufferers aged >21 years, on continual therapy with GC (?5 mg prednisone – PN – equal) and attending rheumatology facilities positioned throughout Italy. Glucocorticoid Induced OsTeoporosis TOol (GIOTTO) is a nationwide multicenter cross-sectional and longitudinal observational research. 553 sufferers affected by Rheumatoid Arthritis (RA), Polymyalgia Rheumatica (PMR) and Connective Tissue Illnesses (CTDs) and in continual therapy with GCs have been enrolled. Osteoporotic BMD values (T rating <-2.5) have been noticed in 28%, 38% and 35% of sufferers with CTDs, PMR or RA on the lumbar backbone, and in 18%, 29% and 26% on the femoral neck, respectively. Earlier than GC therapy, prevalent medical fractures have been reported by 12%, 37% and 17% of sufferers with CTDs, PMR, or RA, respectively. New medical fragility fractures throughout GC therapy have been reported by 12%, 10% and 23% of CTDs, PMR and RA sufferers, respectively. Vertebral fractures have been the prevailing sort of fragility fracture. Greater than 30% of sufferers had recurrence of fracture. A mean of 80% of sufferers have been in supplementation with calcium and/or vitamin D throughout therapy with GCs. Respectively, 64%, 80%, and 72% of the CTDs, PMR and RA sufferers have been on pharmacological therapy for GIOP, nearly solely with bisphosphonates. The GIOTTO research may present related contributions to medical apply, particularly by highlighting and quantifying in actual life the prevalence of GIOP and relative fractures, the frequency of the primary danger elements, and the at the moment sub-optimal prevention. Furthermore, these outcomes emphasize the significance of the underlying rheumatic illness on the chance of GIOP related fractures.
PMID: 28535619 [PubMed – indexed for MEDLINE]