{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T01:16:08Z","timestamp":1783127768187,"version":"3.54.6"},"reference-count":29,"publisher":"Georg Thieme Verlag KG","issue":"05","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"vor","delay-in-days":63,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq Neuropsiquiatr"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Myasthenia gravis (MG) is an autoimmune disease affecting the postsynaptic neuromuscular junction. Treatment often includes corticosteroids, which may reduce bone mass.<\/jats:p>\n                  <jats:p>To evaluate the prevalence and predictors of low bone mineral density (BMD) in MG patients.<\/jats:p>\n                  <jats:p>A cross-sectional study included patients over 18 years with MG followed at the Neuromuscular Diseases Service, Hospital de Cl\u00ednicas, Universidade Federal do Paran\u00e1 (2018\u20132022). Data were obtained through clinical evaluation, medical records, MG Composite Scale, and Quantitative MG Test. Lumbar spine and proximal femur BMD were assessed using a GE Lunar densitometer, with T or Z-scores according to age\/menopausal status. Logistic regression identified factors independently associated with BMD alterations.<\/jats:p>\n                  <jats:p>In total, 92 patients (64.1% female, mean age: 51.3 years) were included, of whom 79.3% had early-onset MG. Past or present corticosteroid use were reported in 94.5 and 45.6%, respectively. Only 27.6% practiced regular physical activity, though most had adequate calcium intake. There were six (7.8%) patients with fragility fractures, and \u2155 were at high fracture risk according to the FRAX results. We found that BMD alterations occurred in 43.5% of patients. No significant association was found with corticosteroid use or MG severity. Age was independently associated with BMD (OR\u2009=\u20091.06, 95% CI: 1.03\u20131.09, p\u2009=\u20090.0005). A cutoff age \u2265 49 years yielded 82.5% sensitivity, 63.5% specificity, and an area under the ROC curve of 0.72 (95% CI: 0.61\u20130.83).<\/jats:p>\n                  <jats:p>Reduced BMD is frequent in MG, highlighting the importance of screening and prevention of low bone mass, osteoporosis, and fragility fractures, particularly in patients over 49 years, regardless of corticosteroid use or MG severity.<\/jats:p>","DOI":"10.1055\/s-0046-1824431","type":"journal-article","created":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T00:24:30Z","timestamp":1783124670000},"page":"001-008","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence and predictors of low bone mineral density in Myasthenia gravis"],"prefix":"10.1055","volume":"84","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1673-5074","authenticated-orcid":false,"given":"Renata Dal-Pr\u00e1","family":"Ducci","sequence":"additional","affiliation":[{"name":"Universidade Federal do Paran\u00e1, Hospital de Cl\u00ednicas, Departamento de Medicina Interna, Divis\u00e3o de Neurologia, Curitiba PR, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3053-936X","authenticated-orcid":false,"given":"Lucas Ferreira","family":"Santana","sequence":"additional","affiliation":[{"name":"Universidade Federal do Paran\u00e1, Hospital de Cl\u00ednicas, Departamento de Medicina Interna, Curitiba PR, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0173-0809","authenticated-orcid":false,"given":"Claudia Kamoi","family":"Kay","sequence":"additional","affiliation":[{"name":"Universidade Federal do Paran\u00e1, Hospital de Cl\u00ednicas, Departamento de Medicina Interna, Divis\u00e3o de Neurologia, Curitiba PR, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9285-0261","authenticated-orcid":false,"given":"Raphael Henrique D\u00e9a","family":"Cirino","sequence":"additional","affiliation":[{"name":"Universidade Federal do Paran\u00e1, Hospital de Cl\u00ednicas, Departamento de Medicina Interna, Curitiba PR, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4457-7771","authenticated-orcid":false,"given":"Paulo Jos\u00e9","family":"Lorenzoni","sequence":"additional","affiliation":[{"name":"Universidade Federal do Paran\u00e1, Hospital de Cl\u00ednicas, Departamento de Medicina Interna, Divis\u00e3o de Neurologia, Curitiba PR, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0778-5376","authenticated-orcid":false,"given":"Otto Jesus Hernandez","family":"Fustes","sequence":"additional","affiliation":[{"name":"Universidade Federal do Paran\u00e1, Hospital de Cl\u00ednicas, Departamento de Medicina Interna, Divis\u00e3o de Neurologia, Curitiba PR, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8024-0009","authenticated-orcid":false,"given":"Paula Raquel Do Vale Pascoal","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"Universidade Federal do Paran\u00e1, Hospital de Cl\u00ednicas, Departamento de Medicina Interna, Divis\u00e3o de Neurologia, Curitiba PR, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9908-4907","authenticated-orcid":false,"given":"Carolina Aguiar","family":"Moreira","sequence":"additional","affiliation":[{"name":"Universidade Federal do Paran\u00e1, Hospital de Cl\u00ednicas, Departamento de Medicina Interna, Divis\u00e3o de Endocrinologia, Curitiba PR, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3957-5317","authenticated-orcid":false,"given":"Rosana Herm\u00ednia","family":"Scola","sequence":"additional","affiliation":[{"name":"Universidade Federal do Paran\u00e1, Hospital de Cl\u00ednicas, Departamento de Medicina Interna, Divis\u00e3o de Neurologia, Curitiba PR, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"issue":"03","key":"ref1","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1007\/s00415-025-12922-7","article-title":"Myasthenia gravis in 2025: five new things and four hopes for the future","volume":"272","author":"S NM Binks","year":"2025","journal-title":"J Neurol"},{"issue":"02","key":"ref2","doi-asserted-by":"publisher","first-page":"59","DOI":"10.33588\/rn.7602.2021201","article-title":"Epidemiolog\u00eda de la miastenia grave en la pen\u00ednsula ib\u00e9rica y Latinoam\u00e9rica[Epidemiology of myasthenia gravis in the Iberian Peninsula and Latin America]","volume":"76","author":"D A Garc\u00eda-Est\u00e9vez","year":"2023","journal-title":"Rev Neurol"},{"issue":"01","key":"ref3","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1038\/s41572-019-0079-y","article-title":"Myasthenia gravis","volume":"5","author":"N E Gilhus","year":"2019","journal-title":"Nat Rev Dis Primers"},{"issue":"10","key":"ref4","doi-asserted-by":"publisher","first-page":"1023","DOI":"10.1016\/s1474-4422(15)00145-3","article-title":"Myasthenia gravis: subgroup classification and therapeutic strategies","volume":"14","author":"N E Gilhus","year":"2015","journal-title":"Lancet Neurol"},{"issue":"12","key":"ref6","doi-asserted-by":"publisher","first-page":"2088","DOI":"10.1002\/art.42646","article-title":"2022 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis","volume":"75","author":"M B Humphrey","year":"2023","journal-title":"Arthritis 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Rondanelli","year":"2021","journal-title":"Nutrients"},{"issue":"17","key":"ref26","doi-asserted-by":"publisher","first-page":"1793","DOI":"10.3390\/healthcare12171793","article-title":"Long-Term Bone Density Changes and Fracture Risk in Myasthenia Gravis: Implications for FRAX\u00ae Tool Application","volume":"12","author":"S Konno","year":"2024","journal-title":"Healthcare (Basel)"},{"issue":"01","key":"ref27","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1186\/s13018-021-02772-0","article-title":"The global prevalence of osteoporosis in the world: a comprehensive systematic review and meta-analysis","volume":"16","author":"N Salari","year":"2021","journal-title":"J Orthop Surg Res"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"123017","DOI":"10.1016\/j.jns.2024.123017","article-title":"Ten-year fracture risk in Japanese patients with myasthenia gravis: A comprehensive assessment using the fracture risk assessment tool","volume":"460","author":"S Konno","year":"2024","journal-title":"J Neurol Sci"},{"issue":"03","key":"ref29","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1007\/s00198-021-06101-3","article-title":"The use of oral glucocorticoids and the risk of major osteoporotic fracture in patients with myasthenia gravis","volume":"33","author":"Z Safipour","year":"2022","journal-title":"Osteoporos Int"},{"issue":"01","key":"ref30","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1007\/s11657-021-00902-z","article-title":"Guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis: an update of Brazilian Society of Rheumatology (2020)","volume":"16","author":"R MR Pereira","year":"2021","journal-title":"Arch Osteoporos"},{"issue":"01","key":"ref31","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s11914-019-00498-x","article-title":"Glucocorticoid-Induced Osteoporosis: New Insights into the Pathophysiology and Treatments","volume":"17","author":"N E Lane","year":"2019","journal-title":"Curr Osteoporos Rep"}],"container-title":["Arquivos de Neuro-Psiquiatria"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0046-1824431.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T00:24:32Z","timestamp":1783124672000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0046-1824431"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":29,"journal-issue":{"issue":"05","published-online":{"date-parts":[[2026,3,11]]},"published-print":{"date-parts":[[2026,5]]}},"alternative-id":["s00461824431"],"URL":"https:\/\/doi.org\/10.1055\/s-0046-1824431","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0004-282X","1678-4227"],"issn-type":[{"value":"0004-282X","type":"print"},{"value":"1678-4227","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]}}}