Longterm, low-dose GC treatment of PMR is associated with serious adverse events such as osteoporosis, fractures, and arterial hypertension; these adverse events occur mostly after 2 years of treatment.

Osteoporosis (OP) and fragility fractures (FFx) are a known comorbidity in patients with systemic lupus erythematosus (SLE). This work aimed at evaluating (1) the prevalence of OP and FFx in a cohort of SLE and (2) the risk factors associated with both OP and FFx. The following data were collected from clinical charts: age, sex, menopausal status (MP), body mass index, smoking habits, disease duration, daily dose and cumulative glucocorticoids (GCs), type of organ involvement, comorbidities and medications. Data on bone metabolism, calcium and vitamin D supplementation and treatment with bisphosphonates, teriparatide or denosumab were collected, together with bone mineral density (BMD) values (measured by dual-energy X-ray absorptiometry (DXA)) and history of FFx (occurred after the onset of SLE and unrelated to trauma). OP and reduced BMD were defined according to the WHO. 186 patients were included (women 175, men 11; mean age 46.4±13 years, mean disease duration 14.9±9 years). At their last visit, 97 patients (52.2%) had a reduced BMD and 52 (27.9%) had OP. 22 patients (11.8%), all women, had at least one FFx; six patients (27.3%) were pre-menopausal. On univariate analysis, age, cumulative dose of GC, MP, therapy with antiepileptics and chronic renal failure (CRF) were correlated with OP (p<0.03); age, total amount of GC, MP, CRF, anticoagulants (AC) and antiepileptic therapy were correlated with FFx (p<0.05). The multivariate logistic model confirmed a direct association of OP and age, MP and antiepileptic therapy (p≤0.01) and of FFx and age, chronic therapy with AC and antiepileptics (p<0.03). In conclusion, low BMD is frequently observed in SLE, and FFx are observed also in premenopausal patients. Together with traditional risk factors (age, MP and GC), CRF and chronic treatments with AC or antiepileptics seem to be associated with a higher risk profile for OP and FFx occurrence.

The aim of this study was to evaluate the adequacy of single-frequency (sf-BIA) and multi-frequency bioelectrical impedance analyses (mf-BIA), in comparison with dual-energy x-ray absorptiometry (DXA), to evaluate body composition in maintenance haemodialysis (MHD) patients. Body composition of 27 adult MHD patients (9 f, 18 m), BMI 17.5-34.4 kg m(-2), was examined with DXA and BIA, with two different sf-BIA and 1 mf-BIA analysers. Biochemical markers of nutritional status and adequacy of dialytic treatment were also determined. Fat mass (FM) estimated by the different BIA analysers was found to be slightly but significantly higher than FM measured by DXA. In contrast, fat-free mass (FFM) obtained with BIA was found to be slightly but significantly lower than FFM DXA. No significant differences were found between LBM-DXA (that is FFM-DXA minus bone mass) and the different FFM BIA. The lowest mean prediction error versus DXA values was found with sf1BIA. In any case, a close correlation was found between all BIA values and DXA values, particularly for FFM. Furthermore, FFM and LBM results were significantly correlated with serum creatinine, which in MHD patients is an indicator of muscle mass. These results indicate that BIA can be used to evaluate body composition in MHD patients.

Forty-three female patients with systemic sclerosis divided into subgroups based on the extent of skin involvement and the presence of calcinosis, and 50 sex and age-matched healthy controls were investigated for bone mineral density (BMD) on the basis of radial (dual photon absorptiometry, Osteograph, NIM), lumbar, and total body measurements (dual energy X-ray absorptiometry, Lunar DPX, Lunar Corp.), and for parameters of calcium metabolism. The patients showed a lower BMD (mean +/- SD; mg/cm2) than the controls at the radial (313 +/- 69 vs 347 +/- 73; p < 0.005), lumbar (974 +/- 143 vs 1081 +/- 154; p < 0.005), and total body (997 +/- 82 vs 1075 +/- 109; p < 0.05) determinations. The patients with the diffuse form of skin involvement had lower values than those with the limited form. There was a negative correlation between BMD and the duration of the disease. The presence of calcinosis was not found to have any effect on BMD. Calcium metabolism was found to be normal in each subgroup. It may be concluded that generalized osteoporosis is a feature of systemic sclerosis, with and without calcinosis. The extent and duration of the disease may play a role in determining bone loss.

Patients with RA treated with low-dose GC compared to patients never treated with GC show a higher prevalence of fractures, arterial hypertension, myocardial infarction, and serious infections, especially after 5 years of GC treatment. The high prevalence of myocardial infarction and fractures in patients with RA suggests that a more accurate identification of risk factors and prevention measures should be adopted when longterm GC treatment is needed.