The impact of low-dose glucocorticoids on disease activity, bone mineral density, fragility fractures, and 10-year probability of fractures in patients with rheumatoid arthritis

This study aimed to investigate the effect of low-dose glucocorticoids (LDGs) on disease activity, bone density, and fractures in patients with rheumatoid arthritis (RA). This was an interim analysis of the RA Registry. Demographic data and clinical characteristics, including fracture risk assessment tool, were collected. 25(OH) Vitamin D, bone mineral density (BMD), and intact parathyroid hormone were measured at enrollment. The study group were those who took LDGs (2.5-7.5 mg/day prednisolone or equivalent dose), and the others were included as the control group. A total of 425 participants were enrolled, including 85 (20%) in the control group and 340 (80%) in the study group. The demographics and clinical characteristics were comparable between the two groups. Compared with the control group, the LDGs group had a significantly lower vertebral BMD (L 1-4) (g/cm 2), (0.854 vs 0.896, p=0.046), significantly higher rate of previous fractures (103 (30.3%) vs 13 (15.3%), p=0.006), higher 10-year probability of major fractures (14 (15.5) vs 8 (8.6), p<0.0001), and higher 10-year probability of hip fractures (4.4 (8.4) vs 2 (3.9), p<0.0001). Disease activity appeared to be similar in the patients with RA regardless of whether or not they received LDG treatment. However, the patients with RA who received LDG treatment had a lower BMD at the spine (L1-4) and a higher rate of previous fractures that was associated with a significantly higher 10-year probability of fractures than those who did not receive LDG treatment.