Endocrine Abstracts

Objective: Describe short- and long-term changes in BMD in adults exposed to varying intensities of systemic glucocorticoid (GC) treatment.

MethodsSetting: Danish Public Health Service Hospital, catchment area 500,000 individuals.

Data: BMD data from 2006-2021 and data on filled prescriptions.

Analysis: All adult patients with at least two DXA exams (left hip), with a minimum of 6 month intervals. Individuals with prescriptions for systemic GCs within 5y of their first DXA scan were excluded, with a 3 month grace period. Observations were censored after initiation of anti-osteoporosis agents. We included 7192 unexposed and 1834 GCs exposed individuals. GC exposure between each two successive scans were standardized into average daily prednisolone equivalent amount. Short-term bone loss (first time slice only) was annualized. Long-term bone loss was visualized with LOWESS scatterplot smoothing.

Results: Short-term bone loss (Table 1): Increasing GC exposure was accompanied by faster BMD loss but also by greater interpersonal variation (IQR Width). Though the majority of patients, both GC treated and untreated, experienced nominally negative trajectories, more than one in five in the upper tertile had a net positive change.

Long-term bone loss: LOWESS of six years of follow up and will be visualized; in brief the lower tertile GC group had lower loss early, but the tertiles approached identical total loss after four years.

Conclusions: These results underscore the heterogeneity of BMD response and highlights the scope for improved predictive models to identify individuals at risk of significantly accelerated bone loss, at the time of initiation of GC treatment.