PREVALENCE AND INCIDENCE OF OSTEOPOROTIC FRACTURES IN PATIENTS ON LONG-TERM GLUCOCORTICOID TREATMENT FOR RHEUMATIC DISEASES: The Glucocorticoid Induced OsTeoporosis TOol, GIOTTO STUDY.

Background: Osteoporosis and fractures are common and invalidating consequences of chronic glucorticoid (GCs) treatment. Reliable information regarding the epidemiology of GCs induced osteoporosis (GIOP) are coming exclusively from the placebo group of randomized clinical trials while observational studies are generally lacking data on the real prevalence of vertebral fractures, GC dose and primary diagnosis. Objectives: The objective of this study was to evaluate the prevalence and incidence of osteoporotic fractures and to identify their major determinants (primary disease, GCs dose, bone mineral density,risk factors, specific treatment for GIOP) in a large cohort of consecutive patients aged > 21 years, on chronic treatment with GC (≥5 mg prednisone –PN- equivalent), attending rheumatology centers located all over Italy. Methods:This is a national multicenter cross-sectional and longitudinal observational study (The Glucocorticoid Induced OsTeoporosis TOol, GIOTTO Study). 553 patients suffering from Rheumatoid Arthritis (RA), Polymyalgia Rheumatica (PMR) and Connective Tissue Diseases (CTDs) and in chronic treatment with GCs were enrolled. Results: Osteoporotic BMD values (T score < -2.5) were observed in 28%, 38% and 35% of the patients with CTDs, PMR or RA at the lumbar spine, and in 18%, 29% and 26% at the femoral neck, respectively. Before GC treatment prevalent clinical fractures had been reported by 12%, 37% and 17% of patients with CTDs, PMR, and RA, respectively. New clinical fragility fractures during GC treatment was reported by 12%, 10% and 23% of CTDs, PMR and RA patients, respectively. Vertebral fractures were the prevailing type of fragility fracture. More than 30% of patients had recurrence of fracture. An average of 80% of patients were in supplementation with calcium and/or vitamin D during treatment with GCs. Respectively,64%, 80%, and 72% of the CTDs, PMR and RApatients were on pharmacological treatment for GIOP, almost exclusively with bisphosphonates. Conclusions: The GIOTTO study might provide relevant contributions in clinical practice, in particular by highlighting and quantifying in real life the prevalence of GIOP and relative fractures, the frequency of the main risk factors, and the currently sub-optimal prevention. Moreover, these results emphasize the importance of the underlying rheumatic disease on the risk of GIOP associated fractures.