AB0830 CG AND DMARDS INDUCED BMD CHANGES IN PRE-, POSTMENOPAUSAL WOMEN AND MAN WITH RHEUMATOID ARTHRITIS (RA)
Authors: Olena Garmish, Andrii Romanovskiy
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Risk factors for GC-induced fracture include low bone strength at the beginning of GC treatment and the rate of decline in bone mass during treatment, which is largely determined by the dose and duration of GC use [1]. The absolute risk of future fracture in an individual is substantially influenced by demographic and other characteristics (age, race, sex, and concomitant OP risk factors). For these reasons, it is important to identify differences in BMD changing depends on sex and reproductive status. <h3>Objectives</h3> To compare the BMD changes in man, pre- and postmenopausal women with RA depends on different treatment regiments. <h3>Methods</h3> The study was performed on 145 patients: 117 women (mean age 45.4±13.0 years, mean disease duration 9.7±7.7 years, 41% (n=48) postmenopausal) and 28 man (mean age 45.5±17.5 years, mean disease duration 5.7±4.8 years) with RA. Female patients were divided in two groups by menopause: premenopausal (PreM) in mean age 36.9±9.3 years and postmenopausal (PM) in the mean age 57.6±5.9 years. 68.4% women and 64.3% man received prednisolon ≤10 mg/day during 5.67±4.82 and 3.5±5.9 years respectively. 60.7% of men received MTX, 50% in combination with CGs. Among the women group 87% PreM patients received MTX, 58.3% in combination with GCs and 46.4% with biologics. 85.4% PM women took MTX, 68.8% in combination with GCs and 33.3% - with biologics. BMD was measured in 3 part of the skeleton: hip (total and neck), lumbar spine, distal part of forearm. <h3>Results</h3> BMD was decreased in 44.5% of women and 42.9% of man. BMD of hip, lumbar spine, distal part of forearm were respectively decreased in 26.1%, 26.1%, 18.8% PreM women and 66.7%, 70.8%, 79.2% PM women. 39.3% of man had decrease BMD in the hip and 42.8% - in the lumbar spine. According to logistic regression in all women group the fact of CG intake was strong associated with BMD decrease in the hip (total and neck) and lumbar spine (r=-0.25, p&lt;0.05), in man no association with the fact of CG intake was found. The effect of CGs on BMD in man was cumulative dose dependent, negative correlation between treatment duration and low hip neck (r=-0.44, p&lt;0.05) and lumbar spine BMD (r=-0.5, p&lt;0.05) was detected. In PreM women only association between CG therapy and decreased total and neck hip BMD (r=-0.33, p&lt;0.05) was detected, any relationship with cumulative dose and treatment duration wasn't found. Only in PM patients BMD decreasing depends on average cumulative dose and treatment duration. MTX intake was negatively correlated with BMD only in PM women in total hip and lumbar spine (r=-0.37, p&lt;0.05) and in men in the distal part of forearm (Z=-2.46, p&lt;0.05). In PM women BMD in total hip and distal part of forearm was significantly higher in MTX+CG+biologics group than without biologics (r=0.38, p&lt;0.05). The level of PTG was significantly higher in PM patients on GCs and was negatively correlation with cumulative dose (r=-0.77, p&lt;0.05). In PreM women GCs intake was negatively correlated with C-TP level (r=-0.37, p&lt;0.05) and positively with RANKL level (r=0.35, p&lt;0.05). <h3>Conclusion</h3> A sexual differences in BMD changes during different treatment regiments was observed in different parts of the skeleton. In man BMD lost in hip and lumbar spine depends on GCs treatment duration and on in the distal part of forearm on MTX intake. In PM women BMD decreasing was strong associated with GC and MTX cumulative dose and treatment duration. <h3>Reference</h3> [1] Lenore Buckley, Gordon Guyatt, Howard A. Fink, et al. 2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis Arthritis Rheum Vol. 69, No. 8, August 2017, pp 1521–1537. <h3>Disclosure of Interests</h3> None declared