Osteoporosis and its Association with Rheumatoid Arthritis and Prednisolone Therapy
Translated title
Osteoporose og dets association med reumatoid artritis og prednisolon behandling
Author
Eriksen, Ane
Term
4. term
Publication year
2014
Submitted on
2014-05-28
Pages
62
Abstract
Osteoporose er en udbredt knoglesygdom, hvor knoglemassen er nedsat, så risikoen for knoglebrud øges. Brud ved osteoporose medfører både sygdomsbyrde, øget dødelighed og store samfundsøkonomiske omkostninger. Langvarig behandling med glukokortikoider som prednisolon og sygdommen reumatoid artrit (leddegigt, RA) er kendte risikofaktorer. Formålet med dette studie var at undersøge sammenhængen mellem prednisolonbehandling, RA og osteoporose. Studiet omfattede alle patienter, der blev henvist til en knogleskanning (DXA) på Aalborg Universitetshospital i 2013 (n=3.557). DXA er en lavdosis røntgenmetode, der måler knogletæthed som en T-score, dvs. hvor meget en persons knogler afviger fra en ung, rask reference; lavere T-score betyder svagere knogler. Vi målte T-scorer for lænderyg (L1–L4) og total hofte og indsamlede øvrige oplysninger via selvudfyldte spørgeskemaer. Mod forventning viste resultaterne, at patienter i behandling med prednisolon havde højere T-scorer i både lænderyg og hofte end patienter uden prednisolon. Der var heller ikke nogen tydelig sammenhæng mellem prednisolondosis og T-score. Patienter med RA havde højere T-score i lænderyg end patienter uden RA, mens hofte-T-scorer var ens mellem grupperne. En trinvis multivariat regressionsanalyse bekræftede, at prednisolonbehandling og RA var positive prædiktorer for T-score i lænderyg, men ikke var forbundet med T-score i hofte. Disse resultater var i modstrid med hypotesen og tidligere studier. Det blev vurderet, at afvigelserne sandsynligvis hang sammen med begrænsninger i dette studie, herunder manglende oplysninger om varigheden af prednisolonbehandling samt sygdomsvarighed og -sværhedsgrad ved RA. Resultaterne bør derfor tolkes med forsigtighed.
Osteoporosis is a common bone disease in which reduced bone mass increases the risk of fractures. Such fractures lead to illness, higher mortality, and substantial societal costs. Long-term treatment with glucocorticoids such as prednisolone and the autoimmune disease rheumatoid arthritis (RA) are known risk factors. This study examined the relationship between prednisolone use, RA, and osteoporosis. It included all patients referred for a bone density scan (DXA) at Aalborg University Hospital in 2013 (n=3,557). DXA is a low-dose X-ray method that reports bone mineral density as a T-score, meaning how much a person’s bones differ from those of a young, healthy reference; a lower T-score indicates weaker bones. We assessed T-scores for the lumbar spine (L1–L4) and total hip and collected additional information via self-completed questionnaires. Contrary to expectations, patients taking prednisolone had higher T-scores in both the lumbar spine and hip than patients not on prednisolone. There was also no clear link between prednisolone dose and T-score. Patients with RA had higher lumbar spine T-scores than those without RA, while hip T-scores were similar between groups. Stepwise multiple linear regression confirmed that prednisolone therapy and RA were positive predictors of lumbar spine T-score but were not associated with hip T-score. These findings conflicted with the study hypothesis and previous research. The discrepancies were thought to reflect study limitations, including missing information on how long patients had been treated with prednisolone and the duration and severity of RA. The results should therefore be interpreted with caution.
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