Development and Comparison of Treatment Decision Tools for Glucocorticoid-Induced Osteoporosis
Long-term Glucocorticoid (GC) use results in compromised bone strength and fractures, and several treatment recommendations have been developed to prevent fractures, but none have been validated in a real-world setting. This study aims to create a treatment decision tool and compares this tool to th...
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| Format: | Article |
| Language: | English |
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MDPI AG
2024-02-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/14/4/452 |
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| author | Jia-Feng Chen Shan-Fu Yu Wen-Chan Chiu Chi-Hua Ko Chung-Yuan Hsu Han-Ming Lai Ying-Chou Chen Yu-Jih Su Hong-Yo Kang Tien-Tsai Cheng |
| author_facet | Jia-Feng Chen Shan-Fu Yu Wen-Chan Chiu Chi-Hua Ko Chung-Yuan Hsu Han-Ming Lai Ying-Chou Chen Yu-Jih Su Hong-Yo Kang Tien-Tsai Cheng |
| author_sort | Jia-Feng Chen |
| collection | DOAJ |
| description | Long-term Glucocorticoid (GC) use results in compromised bone strength and fractures, and several treatment recommendations have been developed to prevent fractures, but none have been validated in a real-world setting. This study aims to create a treatment decision tool and compares this tool to the treatment suggestions from the American College of Rheumatology (ACR), International Osteoporosis Foundation and European Calcified Tissue Society (IOF-ECTS), and GC-adjusted Fracture Risk Assessment Tool (GC-FRAX), above the intervention threshold. We utilized registry data gathered at Chang Gung Memorial Hospital at Kaohsiung, Taiwan, between September 2014 and April 2021. This research is a single-center, observational, and case-controlled study. We recruited participants using prednisone for at least 2.5 mg/day or the equivalent dose for over 3 months, excluding those younger than 40, those with malignancies, or those currently undergoing anti-osteoporosis therapy. The primary endpoint was new fragility fractures within 3 years, including morphometric vertebral fractures detected at baseline and with a follow-up thoracic–lumbar spine X-ray. Participants were randomly allocated into derivation and validation sets. We developed the Steroid-Associated Fracture Evaluation (SAFE) tool in the derivation cohort by assessing the weights of exploratory variables via logistic regression. Prediction performance was compared in the validation set by the receiver operating characteristic (ROC) curve, the area under the curve (AUC), and sensitivity and specificity. A total of 424 treatment-naïve subjects were enrolled, and 83 (19.6%) experienced new fractures within 3 years. The final formula of the SAFE tool includes osteoporosis (1 point), an accumulated GC dose ≥ 750 mg within 6 months (or equivalent prednisolone of ≥4.5 mg/day for 6 months) (1 point), a BMI ≥ 23.5 (1 point), previous fractures (1 point), and elderliness of ≥70 years (2 points). In the validation set, a treatment decision based on the SAFE ≥ 2 points demonstrated an AUC of 0.65, with a sensitivity/specificity/accuracy of 75.9/54.0/58.9, with an ACR of 0.56 (100.0/11.0/31.0), IOF-ECTS 0.61 (75.9/46.0/52.7), and GC-FRAX 0.62 (82.8/42.0/51.2). Among current GIOP recommendations, the SAFE score serves as an appropriate treatment decision tool with increased accuracy and specificity. |
| first_indexed | 2024-03-07T22:35:55Z |
| format | Article |
| id | doaj.art-c7f0d7449fe74dee9ff3c388e3ccf7ae |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-07T22:35:55Z |
| publishDate | 2024-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-c7f0d7449fe74dee9ff3c388e3ccf7ae2024-02-23T15:13:56ZengMDPI AGDiagnostics2075-44182024-02-0114445210.3390/diagnostics14040452Development and Comparison of Treatment Decision Tools for Glucocorticoid-Induced OsteoporosisJia-Feng Chen0Shan-Fu Yu1Wen-Chan Chiu2Chi-Hua Ko3Chung-Yuan Hsu4Han-Ming Lai5Ying-Chou Chen6Yu-Jih Su7Hong-Yo Kang8Tien-Tsai Cheng9Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, Kaohsiung 833, TaiwanDivision of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, Kaohsiung 833, TaiwanDivision of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, Kaohsiung 833, TaiwanDivision of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, Kaohsiung 833, TaiwanDivision of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, Kaohsiung 833, TaiwanDivision of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, Kaohsiung 833, TaiwanDivision of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, Kaohsiung 833, TaiwanDivision of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, Kaohsiung 833, TaiwanGraduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Kaohsiung 833, TaiwanDivision of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, Kaohsiung 833, TaiwanLong-term Glucocorticoid (GC) use results in compromised bone strength and fractures, and several treatment recommendations have been developed to prevent fractures, but none have been validated in a real-world setting. This study aims to create a treatment decision tool and compares this tool to the treatment suggestions from the American College of Rheumatology (ACR), International Osteoporosis Foundation and European Calcified Tissue Society (IOF-ECTS), and GC-adjusted Fracture Risk Assessment Tool (GC-FRAX), above the intervention threshold. We utilized registry data gathered at Chang Gung Memorial Hospital at Kaohsiung, Taiwan, between September 2014 and April 2021. This research is a single-center, observational, and case-controlled study. We recruited participants using prednisone for at least 2.5 mg/day or the equivalent dose for over 3 months, excluding those younger than 40, those with malignancies, or those currently undergoing anti-osteoporosis therapy. The primary endpoint was new fragility fractures within 3 years, including morphometric vertebral fractures detected at baseline and with a follow-up thoracic–lumbar spine X-ray. Participants were randomly allocated into derivation and validation sets. We developed the Steroid-Associated Fracture Evaluation (SAFE) tool in the derivation cohort by assessing the weights of exploratory variables via logistic regression. Prediction performance was compared in the validation set by the receiver operating characteristic (ROC) curve, the area under the curve (AUC), and sensitivity and specificity. A total of 424 treatment-naïve subjects were enrolled, and 83 (19.6%) experienced new fractures within 3 years. The final formula of the SAFE tool includes osteoporosis (1 point), an accumulated GC dose ≥ 750 mg within 6 months (or equivalent prednisolone of ≥4.5 mg/day for 6 months) (1 point), a BMI ≥ 23.5 (1 point), previous fractures (1 point), and elderliness of ≥70 years (2 points). In the validation set, a treatment decision based on the SAFE ≥ 2 points demonstrated an AUC of 0.65, with a sensitivity/specificity/accuracy of 75.9/54.0/58.9, with an ACR of 0.56 (100.0/11.0/31.0), IOF-ECTS 0.61 (75.9/46.0/52.7), and GC-FRAX 0.62 (82.8/42.0/51.2). Among current GIOP recommendations, the SAFE score serves as an appropriate treatment decision tool with increased accuracy and specificity.https://www.mdpi.com/2075-4418/14/4/452corticosteroidsfracture risk assessmentosteoporosisscreeningfracture preventiontreatment |
| spellingShingle | Jia-Feng Chen Shan-Fu Yu Wen-Chan Chiu Chi-Hua Ko Chung-Yuan Hsu Han-Ming Lai Ying-Chou Chen Yu-Jih Su Hong-Yo Kang Tien-Tsai Cheng Development and Comparison of Treatment Decision Tools for Glucocorticoid-Induced Osteoporosis Diagnostics corticosteroids fracture risk assessment osteoporosis screening fracture prevention treatment |
| title | Development and Comparison of Treatment Decision Tools for Glucocorticoid-Induced Osteoporosis |
| title_full | Development and Comparison of Treatment Decision Tools for Glucocorticoid-Induced Osteoporosis |
| title_fullStr | Development and Comparison of Treatment Decision Tools for Glucocorticoid-Induced Osteoporosis |
| title_full_unstemmed | Development and Comparison of Treatment Decision Tools for Glucocorticoid-Induced Osteoporosis |
| title_short | Development and Comparison of Treatment Decision Tools for Glucocorticoid-Induced Osteoporosis |
| title_sort | development and comparison of treatment decision tools for glucocorticoid induced osteoporosis |
| topic | corticosteroids fracture risk assessment osteoporosis screening fracture prevention treatment |
| url | https://www.mdpi.com/2075-4418/14/4/452 |
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