Therapy With Intravenous Methylprednisolone Pulses Is Associated With Loss of Bone Microarchitecture in Trabecular Bone Score -Assessment Among Patients With Moderate-to-Severe Graves' Orbitopathy: A Pilot Study.

Background: Therapy with intravenous glucocorticoids (GCs) is associated with various side effects, however, the impact on bone remains elusive. Trabecular bone score (TBS) is a diagnostic tool providing information on bone microarchitecture based on images obtained from dual-energy X-ray absorptiometry. We investigated the influence of the intravenous methylprednisolone (IVMP) pulse administration on TBS in patients with moderate-to-severe Graves' orbitopathy (GO). Methods: Fifteen patients with GO were treated with 12 IVMP pulses (6x0.5g, 6x0.25 g on a weekly schedule). They received supplementation with 2000 IU of vitamin D and 1.0 g of calcium throughout the study period. TBS was assessed at baseline and after last IVMP pulse. To determine the difference between values at baseline and after treatment the least significant change (LSC) methodology was used. We compared pre- and posttreatment mean TBS values. Results: We found a significant decrease of TBS in 5 out of 15 (33%) patients. Mean TBS value decreased becoming 2.4% lower than at baseline (p<0.05). Conclusions: IVMP pulse therapy exerts negative effect on bone microarchitecture in TBS assessment. The analysis of the clinical risk factors for osteoporosis and the evaluation of bone mineral density and TBS should be considered before initiating IVMP therapy.

High dose intravenous methylprednisolone pulse therapy causes transient increase of serum calcium and phosphate levels.

High and very high doses of intravenous methylprednisolone (IVMP) administered in pulses are the first-line treatment for active, moderateto- severe, as well as sight-threatening Graves' orbitopathy (GO). However, glucocorticoid therapy is associated with side effects, among others, it affects bone metabolism. AIM: The aim of study was to assess the acute effects of high and very high doses of IVMP on calcium (Ca) and phosphate (P) balance in euthyroid patients with moderate-to-severe GO and sight-threatening GO due to dysthyroid optic neuropathy (DON). MATERIALS AND METHODS: Thirty-six patients with active, moderate-tosevere GO were treated with twelve once-weekly pulses (with cumulative dose of 4.5 g IVMP) and 11 patients with DON received 3 intravenous pulses of 1.0 g IVMP on three consecutive days. We measured serum levels of Ca and P at baseline and on the following days after the beginning of the IVMP therapy. RESULTS: We observed a significant increase in serum Ca level on the next day after the 1st IVMP pulse both in patients with moderate-tosevere GO and with DON. Then, on the day 3, the decrease of serum Ca was noticed. In patients with moderate-to-severe GO, on the day 2 serum P showed a significant increase and then, it returned to basal level on the day 3. CONCLUSIONS: We observed a significant increase in serum Ca level on the next day after the 1st IVMP pulse both in patients with moderate-tosevere GO and with DON. Then, on the day 3, the decrease of serum Ca was noticed. In patients with moderate-to-severe GO, on the day 2 serum P showed a significant increase and then, it returned to basal level on the day 3.

Therapy of moderate-to-severe Graves' orbitopathy with intravenous methylprednisolone pulses is not associated with loss of bone mineral density.

PURPOSE: To evaluate the influence of intravenous methylprednisolone (IVMP) pulse administration on bone mineral density (BMD) of the lumbar spine and the femoral neck in patients with moderate-to-severe Graves' orbitopathy (GO). METHODS: Thirty-five patients with GO in euthyreosis were treated with 12 IVMP pulses (6 × 0.5 g, 6 × 0.25 g on a weekly schedule). Supplementation with 1.0 g of calcium and 800 IU of vitamin D was initiated in all patients before beginning therapy. BMD of the lumbar spine (L1-L4) and the femoral neck were assessed at baseline and after the last IVMP pulse using dual-energy X-ray absorptiometry. To determine differences in BMD between values at baseline and after treatment, we used the least significant change (LSC) methodology. LSC values were calculated to be 3 and 5% for the lumbar spine and the femoral neck, respectively. Change in BMD equal to or exceeding the LSC was assessed as either increase or decrease of BMD. We then compared pre-treatment and post-treatment mean BMD values at the lumbar spine and the femoral neck. RESULTS: We did not observe a decrease of BMD at any site equal to or exceeding the LSC. We found an increase of BMD in at least one measurement site equal to or exceeding the LSC value in 43% of patients, mostly in the lumbar spine (31%). Mean femoral neck BMD did not change while mean lumbar BMD increased. CONCLUSIONS: IVMP given in weekly intravenous pulses does not lead to loss of BMD of the lumbar spine and the femoral neck.