GLUCOCORTICOID treatment for rheumatoid arthritis was associated with modest lumbar spine bone loss over two years, although fracture risk remained comparable with standard care, according to a large individual participant data meta-analysis.
Balancing Benefits and Risks of Glucocorticoid Treatment
Low-dose glucocorticoid treatment is frequently used alongside disease-modifying antirheumatic drugs to control rheumatoid arthritis symptoms and inflammation. However, uncertainty remains regarding its long-term effects on bone health. Previous observational studies and clinical trials have produced conflicting findings, particularly concerning bone mineral density loss and fracture risk.
Meta-Analysis Evaluating Bone Outcomes During Treatment
Researchers conducted a protocolised systematic literature review and individual participant data meta-analysis of randomised trials involving early and established rheumatoid arthritis. Eligible studies compared glucocorticoid treatment at doses of 7.5 mg prednisone equivalent per day or lower against placebo or standard care. Background disease-modifying antirheumatic drug therapy was permitted. From 2,336 identified articles, five of six eligible trials provided participant-level data, representing 1,112 individuals. Coprimary outcomes were changes in lumbar spine and femoral bone mineral density and occurrence of at least one clinical fracture over two years using intention-to-treat analyses. Main analyses used one-stage statistical models, while heterogeneity was estimated using two-stage models. Missing data were addressed through multiple imputation, and sensitivity analyses tested robustness.
Lumbar Spine Bone Loss Seen With Glucocorticoid Treatment
Greater bone loss occurred at the lumbar spine in the glucocorticoid treatment group compared with controls, with mean difference −0.021 g/cm² (95% CI −0.037 to −0.005; p=0.034; I²=31%). No significant effect was observed at the femur, with mean difference 0.004 g/cm² (95% CI −0.008 to 0.016; p=0.47; I²=0%). Subgroup analyses did not identify patient groups particularly susceptible to lumbar spine bone loss. Across the analysed cohort, 35 participants experienced at least one clinical fracture, and fracture risk remained similar between glucocorticoid treatment and control groups. Sensitivity analyses yielded consistent findings across models.
Clinical Implications for Rheumatoid Arthritis Management
The findings suggest low-dose glucocorticoid treatment may modestly affect lumbar spine bone density without significantly altering fracture risk over two years. Researchers noted that the clinical relevance of this bone loss may depend on individual osteoporosis risk profiles. Future studies should further clarify long-term skeletal effects and identify strategies to minimise treatment-related bone complications.
Reference
Palmowski A et al. Changes in bone mineral density and fractures during 2 years of low-dose glucocorticoid treatment for rheumatoid arthritis: a systematic literature review and individual participant data meta-analysis. RMD Open. 2026;12:e006615.
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