Bone mineral density and biochemical markers of bone metabolism in late onset rheumatoid arthritis and polymyalgia rheumatica--a prospective study on the influence of glucocorticoid therapy.
In the present prospective study, bone metabolism was examined in 51 patients at the time of diagnosis and 6-7 months later: 29 patients had definitive diagnosis of late onset rheumatoid arthritis (LORA) and 22 patients had polymyalgia rheumatica (PMR). At the time of diagnosis, the patients had not received any medication; during the 6-7 months of follow-up they were treated with corticosteroids and nonsteroidal-antirheumatic drugs (NSAIDs). Serum levels of osteocalcin, alkaline phosphatase and ostase, as markers for bone formation, were tested. Bone density was examined by dual x-ray absorption (DEXA) of the lumbar spine and the left ward triangle. At the time of diagnosis, no signs of bone alterations were seen. After 6-7 months, abnormal values of the serum parameters and bone mineral density were found in 16/51 patients (31%): 10/29 patients with LORA and 6/22 with PMR. Thus, our findings suggest that an alteration of bone metabolism could be observed in a minority of patients during the first few months of glucocorticoid medication, but in the majority of patients an osteoprotective effect seems to be worth discussing. The results suggest from a prophylactic and therapeutic point of view that an additional disease-modifying antirheumatic medication should be considered in the early stages of therapy to reduce the osteoporotic risk of a longterm corticoid therapy.
Lange
U
U
Kerckhoff Clinic and Foundation, Department of Rheumatology, Ludwigstr. 37-39, 61231 Bad Nauheim, Germany.
Boss
B
B
Teichmann
J
J
Stracke
H
H
Neeck
G
G
D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000201:enzymology; D015519:Bone Density / Q000187:drug effects*; D001851:Bone Diseases, Metabolic / Q000139:chemically induced / Q000201:enzymology; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D015675:Osteocalcin / Q000187:drug effects; D011111:Polymyalgia Rheumatica / Q000188:drug therapy* / Q000201:enzymology; D011239:Prednisolone / Q000008:administration & dosage / Q000009:adverse effects*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D015675:Osteocalcin; D011239:Prednisolone; D000469:Alkaline Phosphatase