High prevalence of asymptomatic vertebral fractures in post-menopausal women receiving chronic glucocorticoid therapy: A cross-sectional outpatient study

Angeli, A; Guglielmi, Giuseppe; Dovio, Andrea; Capelli, Giovanni; Feo, Daniela de; Giannini, Sandro; Giorgino, R.; Moro, Luigi; Giustina, Andrea

doi:10.1016/j.bone.2006.02.005

Cited by 318 publications

(202 citation statements)

References 27 publications

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“…The global prevalence of fractures in patients receiving long-term GCs has been reported as 30-50%. In 551 patients receiving long-term GCs, the prevalence of vertebral fractures was 37%, with 14% of patients having 2 or more asymptomatic vertebral fractures; 48% of patients aged ≥70 years and 30% of those aged <60 years had at least one vertebral fracture (53). The increase in fracture risk is immediate, as early as 3 months after the initiation of therapy and it reverses sharply after discontinuation of GCs (24).…”

Section: N Discussion and Conclusionmentioning

confidence: 99%

Prevalence and incidence of osteoporotic fractures in patients on long-term glucocorticoid treatment for rheumatic diseases: the Glucocorticoid Induced OsTeoporosis TOol (GIOTTO) study

et al. 2017

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SUMMARYOsteoporosis and fractures are common and invalidating consequences of chronic glucorticoid (GC) treatment. Reliable information regarding the epidemiology of GC induced osteoporosis (GIOP) comes exclusively from the placebo group of randomized clinical trials while observational studies are generally lacking data on the real prevalence of vertebral fractures, GC dosage and primary diagnosis. The objective of this study was to evaluate the prevalence and incidence of osteoporotic fractures and to identify their major determinants (primary disease, GC dosage, bone mineral density, risk factors, specific treatment for GIOP) in a large cohort of consecutive patients aged >21 years, on chronic treatment with GC (≥5 mg prednisone -PN -equivalent) and attending rheumatology centers located all over Italy. Glucocorticoid Induced OsTeoporosis TOol (GIOTTO) is a national multicenter cross-sectional and longitudinal observational study. 553 patients suffering from Rheumatoid Arthritis (RA), Polymyalgia Rheumatica (PMR) and Connective Tissue Diseases (CTDs) and in chronic treatment with GCs were enrolled. Osteoporotic BMD values (T score <-2.5) were observed in 28%, 38% and 35% of patients with CTDs, PMR or RA at the lumbar spine, and in 18%, 29% and 26% at the femoral neck, respectively. Before GC treatment, prevalent clinical fractures were reported by 12%, 37% and 17% of patients with CTDs, PMR, or RA, respectively. New clinical fragility fractures during GC treatment were reported by 12%, 10% and 23% of CTDs, PMR and RA patients, respectively. Vertebral fractures were the prevailing type of fragility fracture. More than 30% of patients had recurrence of fracture. An average of 80% of patients were in supplementation with calcium and/or vitamin D during treatment with GCs. Respectively, 64%, 80%, and 72% of the CTDs, PMR and RA patients were on pharmacological treatment for GIOP, almost exclusively with bisphosphonates. The GIOTTO study might provide relevant contributions to clinical practice, in particular by highlighting and quantifying in real life the prevalence of GIOP and relative fractures, the frequency of the main risk factors, and the currently sub-optimal prevention. Moreover, these results emphasize the importance of the underlying rheumatic disease on the risk of GIOP associated fractures.

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Section: N Discussion and Conclusionmentioning

confidence: 99%

Prevalence and incidence of osteoporotic fractures in patients on long-term glucocorticoid treatment for rheumatic diseases: the Glucocorticoid Induced OsTeoporosis TOol (GIOTTO) study

et al. 2017

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“…Vertebral compression fractures are commonly missed since only about 30% of them are symptomatic. A study by Angeli et al [127] which examined the prevalence of vertebral fractures in patients receiving glucocorticoids for a variety of autoimmune conditions determined that over 37% of patients had at least one asymptomatic vertebral compression fracture and more than 14% had two or more asymptomatic fractures.…”

Section: Mechanismmentioning

confidence: 99%

Mechanism of Glucocorticoid-Induced Osteoporosis: An Update

Shi¹,

Chutkan²,

Hamrick³

et al. 2012

Glucocorticoids - New Recognition of Our Familiar Friend

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“…In order to avoid misclassification of vertebral deformities, we choose to exclude mild spine deformities from the analysis. Using this approach, it was possible to demonstrate the presence of thoracic vertebral fractures in about 20% of elderly patients suffering from HF, a prevalence about double vs the control population, and comparable with those found in populations known to be at the highest risk for vertebral fractures, such as post-menopausal women in chronic glucocorticoid treatment (34). Moreover, about 10% of these patients had severe and/or multiple vertebral fractures.…”

Section: Discussionmentioning

confidence: 56%

Prevalence of thoracic vertebral fractures in hospitalized elderly patients with heart failure

Mazziotti

Baracca

Doga

et al. 2012

European Journal of Endocrinology

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Objective: Heart failure (HF) has been associated with increased risk of fragility fractures. Indeed, most literature data on fractures were based on an historical and clinical approach focused on the identification of peripheral fractures, whereas the risk of vertebral fractures in this clinical setting is still unclear. Design: Cross-sectional study. Aim: To evaluate the prevalence and determinants of radiological thoracic vertebral fractures in patients with HF. Methods: The study includes 1031 elderly hospitalized patients (491 females and 540 males; median age, 75 years; range, 65-90; 430 patients with HF) who were evaluated for the presence of thoracic vertebral fractures by quantitative morphometric analysis, using chest X-ray routinely performed in the diagnostic work-up of HF. Results: Vertebral fractures were found in 166 patients (16.1%), the prevalence being significantly higher in patients with HF as compared with those without HF, both in females (30.9 vs 15.8%; P!0.001) and in males (16.4 vs 7.4%; PZ0.001). The association between HF and vertebral fractures remained statistically significant (odds ratio, 2.14; 95% CI, 1.25-3.66; PZ0.01) even after adjustment for age, sex, loop diuretic therapy, anticoagulant therapy, proton pump therapy, coexistent chronic obstructive pulmonary disease, diabetes mellitus, renal insufficiency, and chronic liver diseases. In patients with HF, vertebral fractures were positively correlated with female sex, duration of HF, ischemic heart disease, cigarette smoking, and treatment with anti-osteoporotic drugs, and inversely correlated with left ventricular ejection fraction. Conclusions: Hospitalized patients suffering from HF are at higher risk of vertebral fractures than patients without HF in the same clinical context.

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High prevalence of asymptomatic vertebral fractures in post-menopausal women receiving chronic glucocorticoid therapy: A cross-sectional outpatient study

Cited by 318 publications

References 27 publications

Prevalence and incidence of osteoporotic fractures in patients on long-term glucocorticoid treatment for rheumatic diseases: the Glucocorticoid Induced OsTeoporosis TOol (GIOTTO) study

Prevalence and incidence of osteoporotic fractures in patients on long-term glucocorticoid treatment for rheumatic diseases: the Glucocorticoid Induced OsTeoporosis TOol (GIOTTO) study

Mechanism of Glucocorticoid-Induced Osteoporosis: An Update

Prevalence of thoracic vertebral fractures in hospitalized elderly patients with heart failure

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