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Age Dependence of Early Symptomatic Vertebral Fracture with High-Dose Glucocorticoid Treatment for Collagen Vascular Diseases

Department of Clinical Cell Biology (I.T., T.S., S.S., T.Y., T.T., M.S., Y.S.), Chiba University Graduate School of Medicine; Department of Clinical Endocrinology and Metabolism (I.T., S.S., T.Y., T.T., Y.S.), Chiba University Hospital; and Department of Rheumatology (T.S., M.S.), National Hospital Organization Shimoshizu National Hospital, Chiba 260-8670, Japan

Address all correspondence and requests for reprints to: Ichiro Tatsuno M.D., Ph.D, Department of Clinical Cell Biology, Chiba University Graduate School of Medicine 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan. E-mail: ichiro-tatsuno{at}faculty.chiba-u.jp.

Objectives: Collagen vascular diseases requiring treatment with high-dose glucocorticoids are frequently complicated by vertebral fracture. We investigated the incidence of symptomatic vertebral fractures for 20 yr among patients who were treated with high-dose glucocorticoids in the Chiba-Shimoshizu Rheumatic Cohort.

Methods: A total of 2631 patients with collagen vascular diseases (aged 18 yr) was registered between 1986 and 2006. The prevalence of symptomatic vertebral fracture was compared between the high-dose glucocorticoid group newly treated with high-dose glucocorticoids (20 mg/d prednisolone equivalent) (n = 700), and the non-glucocorticoid controls not treated with glucocorticoids (n = 194).

Results: During the 20-yr study period, symptomatic vertebral fractures occurred more frequently in the high-dose glucocorticoid group (23.9%) than in the non-glucocorticoid controls (2.6%). According to a Kaplan-Meier analysis, the cumulative incidence of symptomatic vertebral fracture was significantly higher in the high-dose glucocorticoid group than in the non-glucocorticoid controls (P < 0.001). Stratified into age quartiles of the high-dose glucocorticoid group (age 18–31, 32–47, 48–59, and 60–88 yr), the patients had a markedly increased incidence of symptomatic vertebral fracture with aging. The hazard ratios were also significantly higher in the older age quartile of 60–68 than in the younger age quartile of 32–47 (P < 0.001 for trend). The hazard ratio was 26-fold higher in patients aged 60–88 than in patients aged 18–31 (P < 0.01). In the group with fractures, the treatment duration before fracture was negatively associated with the initial age (r = –0.6587; P < 0.001).

Conclusions: The prevalence of symptomatic vertebral fractures was higher in the patients treated with high-dose glucocorticoids than the untreated controls. Vertebral fractures were age dependent in patients treated with high-dose glucocorticoids. Treatment duration before fracture incidence was significantly shorter in the older patients.