Risk of fractures in patients with rheumatic diseases in treatment with chronic oral corticosteroids

Abstract

INTRODUCTION: Glucocorticoid treatment is necessary as a bridge for other drugs in the treatment of rheumatic diseases. Assessing the risk of fractures in patients with rheumatic diseases in chronic glucocorticoid treatment allow us to establish treatment in time to prevent this complication with a high impact on the quality of life. OBJECTIVES: To evaluat the risk of fractures in patients with rheumatic diseases exposed to chronic use of oral corticosteroids in a private hospital in Córdoba. MATERIAL AND METHODS: Observational, retrospective, case-control study, analytical. Patients, over 18 years of age, outpatient, with a diagnosis of rheumatic diseases treated with oral corticosteroids (doses> 5 mg of prednisone or equivalent) for at least three months, will be evaluated by reviewing medical records at the Clínica Universitaria Reina Fabiola. The characteristics of the patient sample were reported with descriptive statistics. The variables associated with the presence of fractures were analyzed with uni and multivariate logistic regression, the level of significance assigned was p <0.05. Statistical analysis was performed using the SPSS1 22.0 program. RESULTS: The sample consisted of a total of 110 patients, of which 56 had a diagnosis of rheumatic diseases and 55 controls. The patients had a mean age (standard deviation - SD) of 58.95 (14.51) years, most of them female 94 (85.5%). Among the patients with rheumatic disease the diagnoses were: rheumatoid arthritis 38 (35%), seronegative arthritis 7 (7%), systemic lupus erythematosus 7 (7%), polymyalgia rheumatica 2 (2%) and vasculitis 1 (0.9%). Fifty-six patients received corticosteroid therapy, of which 43 (39%) had a medium dose 2.5 -7.5 mg / day, 9 (8%) high dose> 7.5 mg / day and 4 (3.5%) a lower dose less 2.5 mg / day. As for the treatment time, they had a 2.5-month IQR 18 months. The presence of fractures was found in 22 (20%) patients in the total sample at 18 months. In the group of patients with oral corticosteroids and rheumatic disease, the presence of vertebral fractures was 9 (16%) and non-vertebral fractures of 8 (14.2%), while in the control group there was only 1 (1.8%) fracture vertebral and 4 (7.4%) non-vertebral. Regarding the variables associated with fracture risk in the multivariate analysis, it was found that both age 1.06 (95% CI = 1.02-1.11), time of treatment with corticosteroids 1.02 (95% CI 1.00-1.04) and the presence of rheumatic disease 1.85 (95% CI 1.06-3.22) increase the relative risk of fractures. Regarding the presence of vertebral fractures, the variables associated with the increase in relative risk were age 1.12 (95% CI 1.03-1.20), the dose of oral corticosteroids 5.84 (95% CI 1.84-18.55), with high doses being that showed significant difference with an OR 6.58 (95% CI 1.33-20.68) and body mass index under 80.15 (95% CI 3.18-216.63) and in non-vertebral patients were age 1.03 (95% CI 1.00-1.08) and the time of treatment with corticosteroids 1.02 (95% CI 1.00-1.04). CONCLUSIONS: Glucocorticoid-induced OP is the most frequent cause of secondary OP, and is associated with the presence of fractures in up to 30-50% of cases. The risk of fractures depends on factors such as age, previous BMD, daily and cumulative dose of glucocorticoids and underlying disease. Our study demonstrates that chronic glucocorticoid therapy increases the risk of fractures with an OR 1.02, associated with increasing OR 1.06 age and the presence of OR 1.85 rheumatic disease. The high doses being greater than 7.5 mg / day and the BMI under the independent variables associated with the risk of vertebral fracture.