Advances in Glucocorticoid-Induced Osteoporosis

Glucocorticoid-induced osteoporosis (GIOP) is one of the most important side effects of glucocorticoid use, as it leads to an increased risk of fractures. Recently, many published studies have focused on the cellular and molecular mechanisms of bone metabolism, the pathophysiology of GIOP, and the intervention options to prevent GIOP. In this review, recent advances in GIOP are summarized, particularly recent progress in our understanding of the mechanisms of GIOP resulting in improved insight that might result in the development of new treatment options in the near future

A population-based study on mortality and the influence of medication use in 4356 patients with systemic lupus erythematosus and 21845 matched controls from the united kingdom

Background: Systemic lupus erythematosus (SLE) has been associated with an increased mortality rate. However, population-based data on all-cause, agespecific and sex-specific mortality risk are limited and data on the influence of medication exposure on mortality risk in SLE are scarce. Objectives: To estimate the magnitude of the risk from all-cause, age-specific, and sex-specific mortality in patients with SLE and relative risks compared with matched controls, and to evaluate the influence of medication exposure on mortality risk in SLE. Methods: We conducted a population-based cohort study using the Clinical Practice Research Datalink (from 1987 to 2012). Each SLE patient (n=4356) was matched with up to 6 controls (n=21845) by age and sex. Multivariate Cox regression analysis estimated adjusted relative rates (RR) of mortality, and time interaction terms to evaluate mortality timing patterns. Time-dependent Cox models were used to evaluate the association of glucocorticoid use and hydroxychloroquine use on mortality and were adjusted for age, sex, lifestyle parameters, comorbidities and comedication. Results: A total of 442 out of 4356 SLE patients died during the study period. Patients with SLE had an increased mortality rate for all-cause mortality compared with age- and sex-matched subjects, after adjustment for confounders (adjusted RR 1.80, 95% CI 1.57-2.08). Glucocorticoid use in the previous six months raised the mortality rate while the adjusted RR was 45% decreased with low dose hydroxychloroquine use. The RR was highest in patients aged 18-39 years (adjusted RR 4.87, 95% CI 1.93-12.3) and slightly higher in females (adjusted RR 1.82, 95% CI 1.56-2.13) compared to male patients (adjusted RR 1.68, 95% CI 1.19-2.39). The mortality rate was significantly increased for patients with a history of dementia, seizures, diabetes, cancer, and renal disease (Table 1). Conclusions: Patients with SLE have a 1.8-fold increased mortality rate compared with the general population. Glucococorticoid use, female sex and young age are associated with an increased mortality risk while low dose hydroxychloroquine use significantly reduces the mortality rate. In addition, special attention should be paid to lupus patients with neuropsychiatric complications, diabetes, malignancy or renal disease since these subgroups of patients are at high risk of death. (Table presented)

Effect of twelve-month physical exercise program on patients with osteoporotic vertebral fractures: a randomized, controlled trial

Summary: We performed a randomized clinical trial to evaluate the effect of a 12-month physical exercise program on quality of life, balance, and functional mobility in postmenopausal women with osteoporotic vertebral fractures. All three outcomes improved in the intervention group and were better than in the controls. Introduction: Th aim of this study was to evaluate the effectiveness of a structured physical exercise intervention on quality of life, functional mobility, and balance in patients with osteoporotic vertebral fractures and back pain. Methods: Seventy-eight postmenopausal women with vertebral fractures were randomized into an exercise group (n = 40) and a control group (n = 38). The mean age was 69.2 ± 7.7 years. All women had at least one osteoporotic vertebral fracture and suffered from chronic back pain. Patients with a history of vertebral and non-vertebral fracture within the past 6 months were excluded. The 40-min exercise program was conducted twice weekly for 1 year. Participants in the control group were instructed to continue their usual daily activities. Participants were assessed at baseline and at 12 months using the Quality of Life Questionnaire (QUALEFFO-41). Balance was measured with the Balance Master® System NeuroCom® and functional mobility was measured with the “timed up and go” test and “sit-to-stand” test. Results: Total QUALEFFO-41 score after 12 months was significantly better in the exercise group (44.2 ± 7.5) compared to the control group (56.6 ± 9.4), p <0.0001. Quality of life improved in domains: “Pain”, “Physical function: Jobs around the house”, “Physical function: Mobility”, “Social function”, “General health perception” in the exercise group as compared to the control group. After 12 months, balance as assessed by “Tandem Walk and Sway” became significantly better in the exercise group as compared to the control group (p = 0.02). A significant improvement in the “timed up and go” test (p = 0.02) and the “sit-to-stand” test (p = 0.01) was shown in the exercise group compared to the control group. Conclusions: This is the first 12 month-randomized clinical trial of exercise in osteoporotic women with a vertebral fracture that demonstrates improvement of three key outcome measures: quality of life, functional mobility, and balance

A population-based study on mortality and the influence of medication use in 4356 patients with systemic lupus erythematosus and 21845 matched controls from the united kingdom

Background: Systemic lupus erythematosus (SLE) has been associated with an increased mortality rate. However, population-based data on all-cause, agespecific and sex-specific mortality risk are limited and data on the influence of medication exposure on mortality risk in SLE are scarce. Objectives: To estimate the magnitude of the risk from all-cause, age-specific, and sex-specific mortality in patients with SLE and relative risks compared with matched controls, and to evaluate the influence of medication exposure on mortality risk in SLE. Methods: We conducted a population-based cohort study using the Clinical Practice Research Datalink (from 1987 to 2012). Each SLE patient (n=4356) was matched with up to 6 controls (n=21845) by age and sex. Multivariate Cox regression analysis estimated adjusted relative rates (RR) of mortality, and time interaction terms to evaluate mortality timing patterns. Time-dependent Cox models were used to evaluate the association of glucocorticoid use and hydroxychloroquine use on mortality and were adjusted for age, sex, lifestyle parameters, comorbidities and comedication. Results: A total of 442 out of 4356 SLE patients died during the study period. Patients with SLE had an increased mortality rate for all-cause mortality compared with age- and sex-matched subjects, after adjustment for confounders (adjusted RR 1.80, 95% CI 1.57-2.08). Glucocorticoid use in the previous six months raised the mortality rate while the adjusted RR was 45% decreased with low dose hydroxychloroquine use. The RR was highest in patients aged 18-39 years (adjusted RR 4.87, 95% CI 1.93-12.3) and slightly higher in females (adjusted RR 1.82, 95% CI 1.56-2.13) compared to male patients (adjusted RR 1.68, 95% CI 1.19-2.39). The mortality rate was significantly increased for patients with a history of dementia, seizures, diabetes, cancer, and renal disease (Table 1). Conclusions: Patients with SLE have a 1.8-fold increased mortality rate compared with the general population. Glucococorticoid use, female sex and young age are associated with an increased mortality risk while low dose hydroxychloroquine use significantly reduces the mortality rate. In addition, special attention should be paid to lupus patients with neuropsychiatric complications, diabetes, malignancy or renal disease since these subgroups of patients are at high risk of death. (Table presented)