Bad for the Bones

The Effectiveness of Low Dose Glucocorticoids in Reducing Fracture Risk

In this podcast episode, the speaker discusses the potential trade-off between low doses of glucocorticoids and reduced fracture risk in patients with inflammatory rheumatic musculoskeletal diseases. While high doses of glucocorticoids have long been known to be detrimental to bone health, recent studies have suggested that low doses may have some benefits. The speaker references the Gloria trial, which found that five milligrams of prednisone may be beneficial with few adverse effects. However, it is important to note that the use of dual x-ray absorbitometry (DEXA) to measure bone mineral density can sometimes be misleading in patients with glucocorticoid-induced osteoporosis. This is because glucocorticoids not only affect bone density but also the microarchitecture of the bone. The speaker also introduces the derived fracture risk assessment tool (DFRO), which is similar to the FRAX but incorporates additional factors tailored to the Italian population. The speaker presents data from a longitudinal study using the DFRO database, revealing that patients on low doses of glucocorticoids combined with anti-osteoporosis medications can halt or even reverse bone loss. However, patients on higher doses of glucocorticoids continue to experience bone loss. The speaker highlights the importance of considering fracture risk beyond bone mineral density, particularly in patients on glucocorticoids. The study also explores bone turnover markers and discusses the limitations of real-world data and potential confounding factors in interpreting the results.