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

M. Rossini, O. Viapiana, M. Vitiello, N. Malavolta, G. La Montagna, S. Maddali Bongi, O. Di Munno, R. Nuti, C.U. Manzini, C. Ferri, L. Bogliolo, A. Mathieu, F. Cantatore, A. Del Puente, M. Muratore, W. Grassi, B. Frediani, G. Saviola, P. Delvino, L. Mirone, G. Ferraccioli, G. Tripi, I. Piazza, D. Gatti
  • O. Viapiana
    Osteoporosis and Metabolic Skeletal Diseases Study Group of Italian Society of Rheumatology (SIR), Italy
  • M. Vitiello
    Osteoporosis and Metabolic Skeletal Diseases Study Group of Italian Society of Rheumatology (SIR), Italy
  • N. Malavolta
    Osteoporosis and Metabolic Skeletal Diseases Study Group of Italian Society of Rheumatology (SIR), Italy
  • G. La Montagna
    Osteoporosis and Metabolic Skeletal Diseases Study Group of Italian Society of Rheumatology (SIR), Italy
  • S. Maddali Bongi
    Osteoporosis and Metabolic Skeletal Diseases Study Group of Italian Society of Rheumatology (SIR), Italy
  • O. Di Munno
    Osteoporosis and Metabolic Skeletal Diseases Study Group of Italian Society of Rheumatology (SIR), Italy
  • R. Nuti
    Osteoporosis and Metabolic Skeletal Diseases Study Group of Italian Society of Rheumatology (SIR), Italy
  • C.U. Manzini
    Osteoporosis and Metabolic Skeletal Diseases Study Group of Italian Society of Rheumatology (SIR), Italy
  • C. Ferri
    Osteoporosis and Metabolic Skeletal Diseases Study Group of Italian Society of Rheumatology (SIR), Italy
  • L. Bogliolo
    Osteoporosis and Metabolic Skeletal Diseases Study Group of Italian Society of Rheumatology (SIR), Italy
  • A. Mathieu
    Osteoporosis and Metabolic Skeletal Diseases Study Group of Italian Society of Rheumatology (SIR), Italy
  • F. Cantatore
    Osteoporosis and Metabolic Skeletal Diseases Study Group of Italian Society of Rheumatology (SIR), Italy
  • A. Del Puente
    Osteoporosis and Metabolic Skeletal Diseases Study Group of Italian Society of Rheumatology (SIR), Italy
  • M. Muratore
    Osteoporosis and Metabolic Skeletal Diseases Study Group of Italian Society of Rheumatology (SIR), Italy
  • W. Grassi
    Osteoporosis and Metabolic Skeletal Diseases Study Group of Italian Society of Rheumatology (SIR), Italy
  • B. Frediani
    Osteoporosis and Metabolic Skeletal Diseases Study Group of Italian Society of Rheumatology (SIR), Italy
  • G. Saviola
    Osteoporosis and Metabolic Skeletal Diseases Study Group of Italian Society of Rheumatology (SIR), Italy
  • P. Delvino
    Osteoporosis and Metabolic Skeletal Diseases Study Group of Italian Society of Rheumatology (SIR), Italy
  • L. Mirone
    Osteoporosis and Metabolic Skeletal Diseases Study Group of Italian Society of Rheumatology (SIR), Italy
  • G. Ferraccioli
    Osteoporosis and Metabolic Skeletal Diseases Study Group of Italian Society of Rheumatology (SIR), Italy
  • G. Tripi
    Osteoporosis and Metabolic Skeletal Diseases Study Group of Italian Society of Rheumatology (SIR), Italy
  • I. Piazza
    Osteoporosis and Metabolic Skeletal Diseases Study Group of Italian Society of Rheumatology (SIR), Italy
  • D. Gatti
    Osteoporosis and Metabolic Skeletal Diseases Study Group of Italian Society of Rheumatology (SIR), Italy

Abstract

Osteoporosis 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.

Keywords

Glucocorticoids; rheumatic diseases; osteoporosis; fractures.

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Submitted: 2016-09-06 18:53:22
Published: 2017-05-22 16:02:12
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Copyright (c) 2017 M. Rossini, O. Viapiana, M. Vitiello, N. Malavolta, G. La Montagna, S. Maddali Bongi, O. Di Munno, R. Nuti, C.U. Manzini, C. Ferri, L. Bogliolo, A. Mathieu, F. Cantatore, A. Del Puente, M. Muratore, W. Grassi, B. Frediani, G. Saviola, P. Delvino, L. Mirone, G. Ferraccioli, G. Tripi, I. Piazza, D. Gatti

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