Patients with inflammatory rheumatic musculoskeletal diseases (iRMDs) receiving low-dose glucocorticoids should also receive preventive anti-osteoporotic therapy, according to study results presented at ACR Convergence 2022, held from November 10 to 14, in Philadelphia, Pennsylvania.1

Results from the recently published Glucocorticoid Low-dose in Rheumatoid Arthritis (GLORIA) trial incited questions over the benefits of low-dose glucocorticoid use in older patients with inflammatory conditions.

The Glucocorticoid-Induced Osteoporosis Program (GIOP) currently recommends that individuals taking moderate to high doses of glucocorticoids (above 2.5 mg/day) should receive anti-osteoporotic therapy without recommendation of anti-osteoporotic therapy for those on low-dose (below 2.5 mg/day) glucocorticoids.2

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Researchers conducted a 6-year longitudinal cohort study that analyzed the impact of glucocorticoid intake at varying doses (0-2.5 mg/day, 2.5-5 mg/day, and ≥5 mg/day) in 884 women with iRMDs. The researchers also compared these women with iRMD with 1766 healthy, age-matched, and sex-matched controls.

GC doses as low as 2.5 mg/day were associated with BMD loss in iRMDs but this effect was preventable with anti-osteoporotic drugs.

The iRMDs included in the study were rheumatoid arthritis, psoriatic arthritis, systemic sclerosis, polymyalgia rheumatica, spondyloarthritis, systemic lupus erythematosus, and vasculitides.

Prior to initiation of the study, the researchers measured the bone mineral density and evidence of fracture in all participants using dual-energy x-ray absorptiometry (DEXA) scans.

After 6 years, bone mineral density levels decreased significantly in the glucocorticoid recipients who did not receive concurrent anti-osteoporosis treatment. Increased glucocorticoid dose correlated with increased bone mineral density percentage loss without prophylactic anti-osteoporotic therapy. Patients receiving at least 5 mg of glucocorticoids daily demonstrated a 4.26% decrease in bone mineral density (P =.0011), while patients receiving between 2.5 and 5 mg and 0 to 2.5 mg daily demonstrated 4.23% (=.0422) and 2.66% (=.0006) decreases in bone mineral density, respectively.

Anti-osteoporotic therapies improved bone mineral density in patients receiving fewer than 5 mg of glucocorticoids daily, specifically prednisone.

Fractures occurred at higher rates among patients with iRMDs compared with controls. The researchers calculated crude fracture rates of 4.8, 2.8, and 2.5 fractures per 100 person-year for each of the 3 glucocorticoid doses (≥5 mg/day, 2.5-5 mg/day, and 0-2.5 mg/day), respectively. In the control group, 103 fractures occurred at a rate of 2.2 fractures per 100 person-years.

Intake of glucocorticoids of at least 5 mg daily doubled the risk for fracture compared with the other 2 doses and with controls (adjusted hazard ratio: 2.37; 95% CI, 1.33-4.23).

“GC doses as low as 2.5 mg/day were associated with BMD loss in iRMDs but this effect was preventable with anti-osteoporotic drugs,” the study authors conclude. They add, “The latter finding might support anti-osteoporotic treatment initiation in patients taking very low-dose GCs, in direct contrast with most guidelines of GIOP.”

Disclosures: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the author’s disclosures.


  1. Adami G, Fassio A, Bertelle D, Benini C, Gatti D, Rossini M. Impact of glucocorticoid dosing and anti-osteoporotic treatment on bone health in patients with inflammatory rheumatic musculoskeletal diseases: A longitudinal cohort study. Presented at: ACR Convergence 2022; November 10-14; Philadelphia, PA. Abstract/Poster #L01.
  2. Buckley L, Guyatt G, Fink HA, et al. 2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis. Arthritis & Rheumatology. 2017;69(8):1521-1537. doi:10.1002/art.40137

This article originally appeared on Rheumatology Advisor