Table 1.
Summary of studies on osteoporosis and fracture risk in Giant Cell Arteritis (GCA) and Polymyalgia Rheumatica (PMR).
| First author | Year | Study population | Age | Details | Level of evidence | Outcome measures | Results |
|---|---|---|---|---|---|---|---|
| Healey (109) | 1996 | 25 GCA or PMR patients in treatment group 23 GCA or PMR patients in placebo group |
71.6 | RCT of GC-treated GCA or PMR patients receiving calcium, vitamin D and calcitonin, or receiving calcium, vitamin D and placebo | 1b | - Change in BMD at lumbar spine after 2 years - New vertebral fractures at 2 years |
- Mean change in lumbar BMD -0.1% intervention group), -0.2% (placebo) - Vertebral fracture incidence 11% and 14% - Higher cumulative GC dose associated with greater loss in BMD |
| Kermani (107) | 2017 | 204 GCA patients | 71.3 | Prospective cohort of GCA patients | 2b | - Damage items as per Vasculitis Damage Index and LVV Index of Damage | - 22 (10.8%) developed osteoporosis |
| Petri (104) | 2015 | 4671 GCA patients | N/A | Retrospective cohort of GCA patients (n=4671) | 2b | - Incidence of GCA - Cumulative GC dose - Comorbidities associated with GCA |
- RR 2.9 for developing osteoporosis after diagnosis of GCA |
| Mohammad (113) | 2017 | 768 GCA patients 3072 controls |
76.1 | Retrospective cohort of GCA patients | 2b | - Occurrence of osteoporosis or fragility fracture | - RR 2.81 for incident osteoporosis - RR 1.56 for incident fracture |
| Broder (111) | 2016 | 2497 GCA patients | 71 | Retrospective cohort of GCA patients | 2b | - GC-related adverse events including osteoporosis and fragility fracture | - For every 1g increase in cumulative GC dose, HR 1.05 for osteoporosis and 1.04 for fracture - Osteoporosis rate 0.099 events per person year - Fracture rate 0.066 events per person year |
| Gale (57) | 2018 | 8777 GCA patients | 73 | Two retrospective cohorts of GCA patients | 2b | - GC cumulative dose - GC-related adverse events - Association of adverse event risk with GC use greater than 52 weeks |
- OR of osteoporosis for every 1g increase in cumulative GC dose 1.03-1.06 - OR for fracture for every 1g increase in cumulative GC dose 1.02-1.09 - Risk of osteoporosis for every 1g increase in cumulative GC dose 3-3.4% - Risk of fracture for every 1g increase in cumulative GC dose 1-1.9% |
| Hatz (105) | 1992 | 47 GCA or PMR patients | N/A | Prospective cohort of GCA and PMR patients | 2b | - Side effects attributed to GC at 6 months | - 7 (15.0%) developed osteoporosis within 6 months |
| Andersson (114) | 1990 | 26 GCA patients | 78 | Retrospective cohort of GCA patients | 2b | - BMD at heel X-ray signs of osteoporosis |
- 69% of female patients developed severe spinal osteoporosis after 5 years |
| Mazzantini (115) | 2012 | 222 PMR patients | 71 | Retrospective cohort of PMR patients treated with low-dose GC | 2b | - Fragility fractures - Osteoporosis |
- 55 (24.8%) developed osteoporosis - 31 (14.0%) sustained fragility fractures - GC duration and cumulative dose were significantly associated with osteoporosis and fragility fractures |
| Sokhal (110) | 2021 | 652 PMR patients | 72.4 | Prospective cohort of PMR patients | 2b | - Fragility fractures at 12 and 24 months | - 72 (11.0%) sustained fragility fracture within 12 months of diagnosis - 60 (9.2%) sustained fragility fracture 12-24 months after diagnosis |
| Mateo (112) | 1993 | 28 GCA patients 28 PMR patients 48 controls |
N/A | Case-control study of patients with GCA, PMR and controls | 3b | - BMD at lumbar spine and femoral neck | - Age and cumulative GC dose significant predictors of femoral BMD in men - Age and weight, but not cumulative GC dose, were significant predictors of femoral BMD in women - GCA patients had lower BMD |
| Wilson (108) | 2017 | 5011 GCA patients 5011 controls |
72.9 | Retrospective case-control study of GCA patients versus control | 3b | - Incidence of osteoporosis or fracture | - IRR for osteoporosis 2.4 in GCA patients - IRR for fracture 1.4 in GCA patients |
| Paskins (4) | 2018 | 2673 GCA patients 12,136 PMR patients 59,236 controls |
71.9 | Retrospective case-control study of GCA patients PMR patients | 3b | - Time to fracture | - Fracture incidence rate per 10,000 person years 148 for PMR and 147 for GCA - HR for fracture 1.63 for PMR and 1.67 for GCA |
| Wilson (116) | 2017 | 5011 GCA patients | 72.9 | Nested case-control studies of GC doses in GCA | 3b | - Risk of osteoporosis or fracture associated with increasing GC dose | - 511 (10.2%) developed osteoporosis, mean time to developing osteoporosis 3 years - 408 (8.1%) developed fracture, mean time to fracture 3.2 years - Increased risk of osteoporosis with increasing cumulative GC dose |
| Haugeberg (117) | 2000 | GCA or PMR patients - 26 currently treated - 28 previously treated - 30 newly diagnosed |
71 | Cross-sectional study of BMD in currently treated, previously treated and newly diagnosed GCA or PMR patients | 3b | - BMD at radius, spine, hip | - No significant difference in BMD between groups |
GC, glucocorticoid; BMD, bone mineral density; RCT, randomized controlled trial; IRR, incidence rate ratio; OR, odds ratio; RR, relative risk; LVV, large vessel vasculitis; HR, hazard ratio.