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Negative impact of high cumulative glucocorticoid dose on bone metabolism of patients with myasthenia gravis

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Abstract

This current study aimed to evaluate the frequency of low bone mass, osteopenia, and osteoporosis in patients with myasthenia gravis (MG) and to investigate the possible association between bone mineral density (BMD) and plasma levels of bone metabolism markers. Eighty patients with MG and 62 controls BMD were measured in the right femoral neck and lumbar spine by dual-energy X-ray absorptiometry. Plasma concentrations of osteocalcin, osteopontin, osteoprotegerin, tumor necrosis factor (TNF-α), interleukin (IL)-1β, IL-6, dickkopf (DKK-1), sclerostin, insulin, leptin, adrenocorticotropic hormone, parathyroid hormone, and fibroblast growth factor (FGF-23) were analyzed by Luminex®. The mean age of patients was 41.9 years, with 13.5 years of length of illness, and a mean cumulative dose of glucocorticoids 38,123 mg. Patients had significant reduction in BMD of the lumbar, the femoral neck, and in the whole body when compared with controls. Fourteen percent MG patients had osteoporosis at the lumbar spine and 2.5% at the femoral neck. In comparison with controls, patients with MG presented lower levels of osteocalcin, adrenocorticotropic hormone, parathyroid hormone, sclerostin, TNF-α, and DKK-1 and higher levels of FGF-23, leptin, and IL-6. There was a significant negative correlation between cumulative glucocorticoid dose and serum calcium, lumbar spine T-score, femoral neck BMD, T-score, and Z-score. After multivariate analysis, higher TNF-α levels increased the likelihood of presenting low bone mass by 2.62. MG patients under corticotherapy presented low BMD and altered levels of bone markers.

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Acknowledgements

This study was funded by Brazilian government funding agencies Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), and Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG), Brazil.

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Author notes

  1. Antonio Lucio Teixeira

    Present address: Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, BBSB Room 3140, 1941 East Road, Houston, TX, 77054, USA

Authors and Affiliations

  1. Neuroscience Branch, Interdisciplinary Laboratory for Medical Research, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Avenue Alfredo Balena, 190, room 281, Santa Efigenia, Belo Horizonte, MG, 30130-100, Brazil

    Nayara Felicidade Tomaz Braz, Natalia Pessoa Rocha, Érica Leandro Marciano Vieira, Izabela Guimarães Barbosa & Antonio Lucio Teixeira

  2. Neuromuscular Disease Center, University Hospital, UFMG, Belo Horizonte, Brazil

    Rodrigo Santiago Gomez & Antonio Lucio Teixeira

  3. Locomotor System Department, School of Medicine, UFMG, Belo Horizonte, Brazil

    Olívio Brito Malheiro & Adriana Maria Kakehasi

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  1. Nayara Felicidade Tomaz Braz
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  2. Natalia Pessoa Rocha
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Corresponding author

Correspondence to Antonio Lucio Teixeira.

Ethics declarations

All subjects provided written informed consent before admission to the study. The Research Ethics Committee of the Universidade Federal de Minas Gerais, Brazil, approved this study (protocol number: CAAE-19045413.0.0000.5149).

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The authors declare that they have no conflict of interest.

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Braz, N.F.T., Rocha, N.P., Vieira, É.L.M. et al. Negative impact of high cumulative glucocorticoid dose on bone metabolism of patients with myasthenia gravis. Neurol Sci 38, 1405–1413 (2017). https://doi.org/10.1007/s10072-017-2964-z

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  • DOI: https://doi.org/10.1007/s10072-017-2964-z

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