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Effects of glucocorticoids on osteoporosis in rheumatoid arthritis: a systematic review and meta-analysis

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Abstract

We evaluated the effects of glucocorticoids on bone mineral density (BMD), and prevalence of osteoporosis and fracture in rheumatoid arthritis (RA) by meta-analysis. Until June 26, 2019, we conducted a systematic literature search in EMBASE, Web of science, PubMed, and Cochrane Library to obtain BMD and the prevalence of osteoporosis and fracture in glucocorticoid-treated subjects with RA. The BMD of the treatment and control groups were analyzed by meta-analysis (Stata. version 15), and the 95% confidence interval (CI) was calculated. We identified 15 observational studies, including 46,711 RA subjects and 857 healthy controls. The BMD of the lumbar spine (− 0.038 g/cm2; CI, − 0.052, − 0.024) and femoral neck (− 0.017 g/cm2; − 0.030, − 0.003) in RA treated with glucocorticoids were significantly lower than those in RA controls. Compared with healthy control group, the BMD of the lumbar spine (− 0.094 g/cm2; − 0.126, − 0.061) and femoral neck (− 0.097 g/cm2, − 0.109, − 0.085) of RA treated with glucocorticoids decreased more significantly. The prevalence of osteoporosis in whole body, spine, and femur was 38.6% (0.305, 0.466), 32.9% (0.277, 0.381), and 21.7% (0.106, 0.328), respectively. And the prevalence of vertebral fracture was 13.0% (0.058, 0.203). Glucocorticoids may lead to a decline in skeletal health in subjects with RA, especially in vertebral and femoral BMD, compared with normal people or RA without glucocorticoid therapy. Meanwhile, osteoporosis and fractures were also common. Therapeutic measures should be targeted at individuals, which needs further study. Through meta-analysis, we found that glucocorticoids have some negative effects on the bone health of subjects with rheumatoid arthritis. Therefore, when using glucocorticoids to treat rheumatoid arthritis, we should take strategic measures to prevent the decline of bone quality.

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Funding

This study was funded by the National Natural Science Foundation of China (grant numbers 81671616, 81871278) and the Science and technology Project of Jiangsu Province (grant number BE2018671).

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Author notes

  1. Y. Wang and R. Zhao contributed equally to this work.

Authors and Affiliations

  1. Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, China

    Y. Wang, R. Zhao & C. Dong

  2. Department of Nursing, Affiliated Hospital of Nantong University, Nantong, China

    Y. Wang & R. Zhao

  3. Research Center of Gerontology and Longevity, Affiliated Hospital of Nantong University, Nantong, China

    Z. Gu & C. Dong

  4. Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong, 226001, Jiangsu Province, People’s Republic of China

    Z. Gu & G. Guo

  5. Department of Gastroenterology, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong, 226001, Jiangsu Province, People’s Republic of China

    L. Li

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  1. Y. Wang
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Wang, Y., Zhao, R., Gu, Z. et al. Effects of glucocorticoids on osteoporosis in rheumatoid arthritis: a systematic review and meta-analysis. Osteoporos Int 31, 1401–1409 (2020). https://doi.org/10.1007/s00198-020-05360-w

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