@article {Floreze001355, author = {Helena Florez and Jose Hern{\'a}ndez-Rodr{\'\i}guez and Josep Lluis Carrasco and Sergio Prieto-Gonz{\'a}lez and Africa Muxi and Xavier Filella and Silvia Ruiz-Gasp{\`a} and Jos{\'e} A G{\'o}mez-Puerta and Maria Cid and Gerard Espinosa and Ana Monegal and N{\'u}ria Gua{\~n}abens and Pilar Peris}, title = {Vertebral fracture risk in glucocorticoid-induced osteoporosis: the role of hypogonadism and corticosteroid boluses}, volume = {6}, number = {2}, elocation-id = {e001355}, year = {2020}, doi = {10.1136/rmdopen-2020-001355}, publisher = {BMJ Specialist Journals}, abstract = {Objective The aim of this study was to identify the risk factors associated with fragility fracture (FF) development in glucocorticoid (GC)-treated patients.Methods 127 patients (aged 62{\textpm}18~years, 63\% women) on GC-treatment (mean dose 14.5{\textpm}14.1 mg/day and duration 47.7{\textpm}69~months) were included. The clinical data collected included bone metabolism study (including gonadal axis), GC-treatment, disease activity, dual-energy X-ray absorptiometry analysis (evaluating densitometric osteoporosis (OP) and trabecular bone score (TBS) degraded microarchitecture values (DMA)), X-ray (assessing vertebral fractures (VF)), FRAX risk (GC-adjusted) and previous FF.Results 17\% of the patients had VF, 28\% FF (VF and/or non-VF), 29\% OP and 52\% DMA. Patients with VF received more GC boluses (57.1\% vs 29.5\%, p=0.03), were older (68{\textpm}13 vs 60{\textpm}19~years, p=0.02), postmenopausal (100\% vs 67\%, p=0.02), had low testosterone levels (57\% vs 11\%, p=0.02), lower TBS values (1.119{\textpm}0.03 vs 1.237{\textpm}0.013, p\<0.001) and higher FRAX risk (17.2{\textpm}16 vs 9.3{\textpm}7.6, p=0.003). Patients with FF showed higher accumulated GC doses (16.6{\textpm}18.4 vs 11.1{\textpm}12.9~g, p=0.046). On multivariate analysis, hypogonadism (OR 12.38; 95\% CI 1.85 to \>100, p=0.01) and having received GC boluses (OR 3.45; 95\% CI 1.04 to 12.15, p=0.01) were the main factors related to VF. Hypogonadism (OR 7.03; 95\% CI 1.47 to 38.37, p=0.01) and FRAX \>20 (OR 7.08; 95\% CI 1.28 to 53.71, p=0.02) were factors related to FF.Conclusion Hypogonadism is the principal risk factor for developing fractures in GC-treated men and women, whereas receiving GC boluses is a major factor for VF. These results indicate the importance of evaluating the gonadal axis in these patients.}, URL = {https://rmdopen.bmj.com/content/6/2/e001355}, eprint = {https://rmdopen.bmj.com/content/6/2/e001355.full.pdf}, journal = {RMD Open} }