A. Nack, I. Casafont-Solé, L. Mateo, S. Holgado Pérez, M. Martínez-Morillo, M. Aparicio Espinar, A. Riveros, C. Sanguesa, Á. Prior-Español, M. Aparicio Rovira, A. Olive, L. Gifre
2020 Annals of the Rheumatic Diseases  
Background:There are several studies assessing bone mass and osteoporosis (OP) development of patients with giant cell arteritis (GCA) during glucocorticoid treatment, however data at time of diagnosis is scarce.Objectives:To analyze bone metabolism, bone mineral density (BMD) and trabecular microarchitecture by measuring trabecular bone score (TBS) in patients with recent diagnosis of GCA.Methods:Retrospective observational study in which we included all patients with GCA and bone metabolism
more » ... sessment at diagnosis. We recorded: risk factors for OP (previous fractures and anti-OP treatments), bone metabolism (calcium, phosphate, PTH, 25-vitaminD [25-OHD]) and the DXA results (Lunar, DPX) at the time of diagnosis and during the follow-up. The statistic analysis was made with SPSS.Results:36 patients (27 W: 9M) with a mean age of 76±9 years were included. The clinical characteristics of the GCA at diagnoses were: headache (81%), constitutional syndrome (58%), allodynia (42%), visual loss (42%, binocular in 2 patients), jaw claudication (39%), polymyalgic syndrome (28%), amaurosis fugax (25%) and lingular necrosis (n=1, 3%). Additional diagnosis tests included: temporal biopsy (86%, being pathologic in 55%), temporal ultrasound (97%, pathologic 34%), extra-cranial arteries ultrasound (81%, pathologic 7%) and PET/CT (19%, pathologic 86%). Up to 61% received three metilprednisolone bolus (mean dose 1700mg). 7 patients (19%) had previous OP and 3 had already suffered a fragility fracture (Colles, vertebral and femur). Only 4 patients were receiving anti-OP treatment (2 oral bisphosphonate, 2 zoledronate).At time of diagnosis of GCA, the mean of 25OHD was 17±13ng/mL (88%, <30). BMD showed low bone mass in 80% of patients (47% with OP, 33% osteopenia). The mean TBS was 1.026±0.098 and up to 38% showed poor bone microarchitecture [values <1.23]). No significant differences were observed between patients with or without TBS <1.23. Up to 94% of patients received anti-OP treatment (26 zoledronate, 6 oral bisphosphonate, 1 denosumab, 1 teriparatide). 3 patients had incidental fractures during the follow-up, however no relation was found with BMD or TBS.Conclusion:Low bone mass and vitamin D insufficiency are frequent in patients with recent diagnoses of GCA and up to 38% have poor bone microarchitecture at baseline. Thus, it's important to perform a bone mass assessment in all patients with recent diagnose of ACG and initiate therapeutic or preventive anti-OP treatment if required.Disclosure of Interests:None declared
doi:10.1136/annrheumdis-2020-eular.3047 fatcat:qo73q2aldfbonovqom7vye3uli