Giovanni Adami, MD, PhDc: Glucocorticoids and fracture risk

Giovanni Adami MD, PhDc
Giovanni Adami MD, PhDc

Poster presenter: Giovanni Adami, MD, PhDc, Rheumatology Unit, University of Verona

Poster title: Risk of Fracture in Patients with Different Glucocorticoid Requiring Diseases

Scheduled poster session day and time: Friday, Nov. 6, 9 – 11 a.m. EST

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What is your poster about?

We conducted an observational retrospective analysis on a nationwide dataset (approximately 60,000 individuals) that originated from a web-based fracture risk-assessment tool. We analyzed through propensity score matching the independent role of glucocorticoids (GCs) and various GC-requiring diseases on fracture risk. In aggregate, we found that GC use at therapeutic doses (≥5 mg/day of prednisone equivalent for >3 months) was associated with an increased risk of fracture. Younger patients taking GCs were at risk of vertebral or hip fractures, while older individuals were at risk of fracture of any kind. COPD and neurological diseases were independently associated with both vertebral and non-vertebral fracture risk, while rheumatoid arthritis was independently associated with non-vertebral, non-hip fractures. These associations were independent from bone mineral density (BMD) levels and GC intake, further highlighting the deleterious effects that systemic inflammation has on bone.

Why did you decide to investigate this topic?

My research interest is in both metabolic bone diseases and inflammatory arthritides. We decided to explore the independent effect of GCs and diseases on fracture risk. There is still controversy on safe GC doses, and our study might help further clarify that there is no safe dose in RA patients. Those patients are at risk independently from GC intake or BMD levels.

What excites you most about your work?

Our study showed the great potential for epidemiological research resulting from the application, in the clinical practice, of a fracture risk prediction algorithm. Our study added to a growing body of literature on glucocorticoid-induced osteoporosis and fracture risk associated with GC-requiring diseases. We demonstrated that RA and other inflammatory non-rheumatic diseases are independently associated with fracture risk. This finding implies important consequences in the management of bone health in such patients, especially when they withdraw GCs.

What are you working on next related to this poster? 

We are now working on the effect of anti-osteoporotic medications in rheumatoid arthritis patients and their potential in improving both systemic bone health and local bone health (erosive disease).