ECE2024 Poster Presentations Adrenal and Cardiovascular Endocrinology (95 abstracts)
Musculoskeletal health and body composition in patients discontinuing long-term prednisolone treatment – prospective data from the replace Study
Lise Sofie Bislev 1 , Marie Louise Lund 2 , Anja Fenger Dreyer 3 , Hajir Al-Jorani 3 , Victor Brun Boesen 2 , Stina Willemoes Borresen 2 , LouiseLehmann Christensen 3 , Ulla Feldt-Rasmussen 2 , Dorte Glintborg 3 , SimonBøggild Hansen 1 , Richard Christian Jensen 3 , Nanna Thurmann Jørgensen 2 , Jelena Stankovic 1 , Randi Tei 1 , Marianne Skovsager Andersen 3 , Marianne Klose 2 & Jens OttoLunde Jørgensen 1
1Palle Juul-Jensens Boulevard, Aarhus, Denmark; 2Blegdamsvej 9, København, Denmark; 3J. B. Winsløws Vej 4, Odense, Denmark
Background: Pharmacological glucocorticoid (GC) treatment exerts adverse effects on musculoskeletal health and may induce glucocorticoid-induced adrenal insufficiency (GIA), but these features have so far not been characterized in a prospective and unbiased manner.
Aim: To characterize a population, who recently discontinued long-term (>12 weeks) prednisolone treatment with particular emphasis on the presence or absence of symptoms.
Methods: A prospective nationwide study (REPLACE) including baseline data from 116 patients with polymyalgia rheumatica/giant cell arteritis in GC-free remission for 2–12 weeks. The participants completed a disease-specific questionnaire (AddiQoL-30) where a score <85 was defined as presence of GIA symptoms. Musculoskeletal health and body composition were assessed by DXA scans, functional tests, and in a subgroup HRpQCT scans (n=34).
Results: The participant median (range) age was 73 (51-88) years (56% women) with a median [IQR] prednisolone treatment duration of 12.5 [10.0 -17.8] months and an accumulated dose of 323 mg [217 – 481] six months before inclusion. n=42 (36%) reported symptomatic GIA. Median (range) morning basal cortisol (nmol/l) was 258 (101 – 470) in the symptomatic GIA group vs 291 (135-497) in the group without symptomatic GIA, P=0.01. Median [IQR] adult fractures were 1 [1; 2]. Four out of five received calcium/vitamin D, and 38% anti-osteoporotic medication (all bisphosphonates). Only 18% of patients did not meet criteria for (prophylactic) bisphosphonate treatment, defined by a T-score <1 in hip/lumbar spine and/or a diagnostic fracture. Sarcopenia, defined as appendicular lean mass index <7.26/5.45 kg/m2 for men/women, was present in 18%. Stratifying for GIA symptoms, patients showed no differences in bone health, fractures, anti-osteoporotic treatment, comorbidity or HbA1c. Patients with GIA symptoms had lower ionized calcium (1.23 vs 1.25 nmol/l, p=0.04), reduced grip strength (19.5 vs 28.5 kg, P=0.05), and a longer Time Up and Go test duration (7.7 vs 6.7 s, P=0.03). No differences in muscle/appendicular lean mass were observed, but patients with GIA symptoms had a higher fat percentage (41.2 vs 36.5%, P=0.02) and larger waist circumference (99.1 vs 93.8 cm, P=0.03). The results on muscle function and body composition remained significant after adjusting for age and gender.
Conclusions: 1) The majority of long-term prednisolone users requires (prophylactic) osteoporosis treatment. 2) GIA symptoms are accompanied by impaired muscle function and increased abdominal fat. 3) We hypothesize that GIA symptoms are a component of the steroid withdrawal syndrome, which merits clinical attention.
EudraCT (2020-006121-65). Funding: NNF20OC0063280
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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