ABSTRACT
Objective:To investigate the incidence of and risk factors for osteoporosis in patients with pemphigus treated with systemic glucocorticoids, and to analyze the current status of prevention and treatment of osteoporosis.Methods:Clinical data were collected from 101 inpatients with pemphigus treated in Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College from January 2014 to January 2019, and these patients were divided into osteoporosis group ( n= 21) and non-osteoporosis group ( n= 80) according to their bone mineral density (BMD) values. Correlations of osteoporosis with patients′ general information, treatment duration and cumulative dose of glucocorticoids, application of immunosuppressive agents, diabetes mellitus, hypertension, hyperlipidemia, smoking, outdoor activity and other factors were analyzed, and the application status of calcium supplements, vitamin D and bisphosphonates was also analyzed. Enumeration data were compared by using chi-square test, measurement data were compared by using t test, and multiple factors influencing osteoporosis were analyzed by using non-conditional Logistic regression analysis. Results:Logistic regression analysis showed that age ( P= 0.001, OR= 1.08, 95% CI: 1.03- 1.14) and cumulative dose of glucocorticoids ( P<0.001, OR= 1.72, 95% CI: 1.18- 2.52) were risk factors for the occurrence of osteoporosis, while outdoor activity ( P<0.001, OR= 0.04, 95% CI: 0.01- 0.21) was a protective factor. Moreover, 13 (61.9%) patients in the osteoporosis group and 16 (21.6%) patients in the non-osteoporosis group received combination treatment with calcium supplements, vitamin D and bisphosphonates. Conclusions:Pemphigus patients treated with systemic glucocorticoids are prone to develop osteoporosis. Older age, cumulative dose of glucocorticoids may be risk factors for osteoporosis in patients with pemphigus, while outdoor activity may be a protective factor. The prevention and treatment of osteoporosis in pemphigus patients are still not standardized.
ABSTRACT
Objective To investigate the prevalence of and risk factors for glucocorticoid-induced diabetes mellitus (GDM) in patients with pemphigus or pemphigoid receiving glucocorticoid therapy.Methods This study included 68 hospitalized patients with pemphigus or pemphigoid receiving glucocorticoid therapy in the Institute of Dermatology,Chinese Academy of Medical Sciences and Peking Union Medical College from December 2011 to January 2013.Comparisons were carried out between patients with GDM and those without regarding multiple parameters,including age,sex,body mass index (BMI),pathological type,initial dose and maximum daily dose of glucocorticoids,family history of diabetes mellitus,immunosuppressive treatment,etc.Independent samples t test was used for intergroup comparisons,Chi-square test and Fisher exact probability test for the analysis of count data,and a logistic regression model for the determination of risk factors.Results Among the 68 patients,26 (38.2％) developed GDM during glucocorticoid therapy.Univariate logistic regression analysis showed that the initial dose of glucocorticoids (P ＜ 0.05,OR 1.023,95％ CI 1.002-1.044),maximum daily dose of glucocorticoids(P ＜ 0.01,OR 1.037,95％ CI 1.013-1.062),duration of glucocorticoid treatment (P ＜ 0.05,OR 1.143,95％ CI 1.028-1.271),BMI (P ＜ 0.01,OR 1.265,95％ CI 1.080-1.481) and dexamethasone use (P ＜ 0.01,OR 6.0,95％ CI 1.887-19.076) were risk factors for GDM in these patients.Multivariate logistic regression analysis showed that BMI (P ＜ 0.05,OR 1.223,95％ CI 1.017-1.471) and maximum daily dose of glucocorticoids (P ＜ 0.05,OR 1.037,95％ CI 1.009-1.065) were independent risk factors for GDM.Conclusions In this study,38.2％ of the patients with pemphigus or pemphigoid developed GDM during glucocorticoid therapy.BMI and maximum daily dose of glucocorticoids seem to be independent risk factors for GDM.