Effects of Low Dose Corticosteroids on the Bone Mineral Density of Patients with RA

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Presentation Number:624

Poster Board Number:624

Presentation Time:11/8/2007 8:00:00 AM

Title:Effects of Low Dose Corticosteroids on the Bone Mineral Density of

Patients with Rheumatoid Arthritis: A Meta-Analysis

Category:8. Osteoporosis and metabolic bone disease: clinical aspects and

pathogenesis

Author(s):Young Ho Lee, Young Hee Rho, Seong Jae Choi, Jin Hyun Woo, Jong

Dae Ji, Gwan Gyu Song. Division of Rheumatolgy, Korea University Medical

Center, Seoul, Republic of Korea

PURPOSE: The effect of long-term high dose corticosteroid on bone mineral

density (BMD) is clear, but there is some controversy on the effect of low

dose corticosteroids in rheumatoid arthritis (RA) patients. It has been

suggested that the favorable effects of corticosteroid on the inflammatory

process and on physical activity may outweigh the negative effects of the

drug on bone. The aim is to assess the effect of low dose corticosteroids on

the BMD of patients with RA.

METHODS: We surveyed randomized controlled studies that examined the effects

of low dose corticosteroids on BMD in RA patients through Medline and

Cochrane and manual searches. We collected data on BMD (end-of-period or

change-from-baseline) at the longest duration. A meta-analysis used a random

effects model with outcomes given as standardized mean differences.

RESULTS: Seven studies were included in the meta-analysis. There were 7

studies for lumber BMD meta-analysis and 6 studies for femur BMD

meta-analysis. Corticosteroid had a marked effect over control on lumbar

BMD, whereas the difference in femur BMD was not significant. Subgroup

analysis by BMD data from change-from-base showed that corticosteroid had a

clear effect over control on both lumbar and femur BMDs, without

between-study heterogeneity.

CONCLUSIONS: Meta-analysis showed greater BMD loss after corticosteroid

treatment in RA patients. It is concluded that low dose corticosteroids for

the treatment of RA may increase bone loss, since BMD was significantly

reduced by low dose corticosteroid in RA patients. These findings could have

practical implication in the long-term management of low dose corticosteroid

for RA patients.

Disclosures: Y. Lee, None; Y. Rho, None; S. Choi, None; J. Woo, None; J. Ji,

None; G. Song, None.