The effect of glucocorticoids on bone mass in rheumatoid arthritis patients. Influence of menopausal state

We studied 97 patients with definite or classic rheumatoid arthritis (RA). Fifty-four patients (19 premenopausal women, 25 postmenopausal women, and 10 men) had been treated with low-dose glucocorticoids for at least 12 months (mean dose less than 10 mg/day). The remaining 43 patients (15 premenopausal women, 17 postmenopausal women, and 11 men) had been treated with penicillamine, and served as a patient control group. The distal forearm bone mineral content (BMC) was measured in all patients by single photon absorptiometry using 125I, and the total body bone mineral (TBBM) was measured in 61 patients by dual photon absorptiometry using 153Gd. Compared with normal controls, both treatment groups had significantly decreased BMC and TBBM (0.01 less than P less than 0.001). When the patients were stratified according to pre- and postmenopausal state, we found significantly lower BMC and TBBM values in the premenopausal glucocorticoid-treated women than in penicillamine-treated women. However, no differences in BMC and TBBM values were found in the corresponding postmenopausal groups. In the premenopausal women treated with glucocorticoids, the duration of treatment and cumulative dose correlated with BMC. No such correlations were found in the postmenopausal women. We conclude that 1) RA is associated with loss of bone mass, 2) systemic glucocorticoid treatment further aggravates the bone loss, 3) in postmenopausal RA patients, the bone loss resulting from menopause and from the disease itself is not accelerated by low-dose glucocorticoids, and 4) in premenopausal RA patients, however, the bone mass is significantly affected by glucocorticoid treatment. We therefore suggest that these factors be considered when prescribing glucocorticoids, in order to minimize the bone loss.