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

Nayara Felicidade Tomaz Braz, Natalia Pessoa Rocha, Érica Leandro Marciano Vieira, Rodrigo Santiago Gomez, Izabela Guimarães Barbosa, Olívio Brito Malheiro, Adriana Maria Kakehasi, Antonio Lucio Teixeira

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1405-1413
Number of pages9
JournalNeurological Sciences
Issue number8
StatePublished - Aug 1 2017
Externally publishedYes


  • Bone metabolism markers
  • Bone mineral density
  • Dual-energy X-ray absorptiometry
  • Myasthenia gravis
  • Osteoporosis

ASJC Scopus subject areas

  • Dermatology
  • Clinical Neurology
  • Psychiatry and Mental health


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