Effects of Low-Dose Corticosteroids on the Bone Mineral Density of Patients With Rheumatoid Arthritis: A Meta-Analysis
- Authors
- Lee, Young Ho; Woo, Jin-Hyun; Choi, Seong Jae; Ji, Jong Dae; Song, Gwan Gyu
- Issue Date
- 12월-2008
- Publisher
- BMJ PUBLISHING GROUP
- Keywords
- corticosteroid; bone mineral density; rheumatoid arthritis
- Citation
- JOURNAL OF INVESTIGATIVE MEDICINE, v.56, no.8, pp.1011 - 1018
- Indexed
- SCIE
SCOPUS
- Journal Title
- JOURNAL OF INVESTIGATIVE MEDICINE
- Volume
- 56
- Number
- 8
- Start Page
- 1011
- End Page
- 1018
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/122340
- DOI
- 10.2310/JIM.0b013e31818e82d7
- ISSN
- 1081-5589
- Abstract
- Background: The effects of long-term high-dose corticosteroids on bone mineral density (BMD) are clear, but the effects of low-dose corticosteroids in patients with rheumatoid arthritis (RA) remain controversial. The aim of this study was to assess the effects of low-dose corticosteroids on BMD in patients with RA. Methods: The authors surveyed randomized controlled studies that examined the effects of low-dose corticosteroids on BMD in patients with RA using MEDLINE and the Cochrane Controlled Trials Register and by performing manual searches. Data were collected on BMD (end-of-period or change-from-baseline) after longest recorded treatment durations. Meta-analysis was performed using a random effects model; outcomes are presented as standardized mean differences (SMDs). Results: Seven studies were included in this meta-analysis, which included 7 studies on lumbar BMD meta-analysis and 6 studies on femur BMD meta-analysis. Corticosteroids resulted in a moderate worsening in lumbar BMD compared with controls (SMD = -0.483; 95% confidence interval [Cl], - 0.815 to - 0.151, P = 0.004), whereas the femoral BMD differences were not siginificant (SMD = -0.224; 95% Cl, -0.663 to 0.215, P = 0.318). Subgroup analysis of BMD data performed on a change-from-baseline basis showed that corticosteroids had a clear effect on both lumbar and femoral BMDs (SMD = -0.354; 95% Cl, -0.620 to -0.088, P = 0.009; SMD = -0.488; 95% Cl, -0.911 to -0.065, P = 0.024, respectively). Conclusions: This meta-analysis shows BMD loss after low-dose corticosteroid treatment in patients with RA. These findings have practical implications for the long-term management of patients with RA on low-dose corticosteroids.
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