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Osteoporosis International

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01-01-2016 | Original Article

Bone status in glucocorticoid-treated men and women

Authors: E. S. Leib, R. Winzenrieth

Published in: Osteoporosis International | Issue 1/2016

Abstract

Summary

We recorded the results of areal bone mineral density (aBMD) and microarchitecture of the bone measured by trabecular bone score (TBS) in 416 glucocorticoid-treated men and women aged 40 years and older with or without fracture to 1104 controls. TBS better discriminated those with fracture compared to aBMD. These differences were the greatest in men.

Introduction

The aim of this study is to evaluate glucocorticoid (GC)-induced effects on areal bone mineral density (aBMD) and bone microarchitectural texture measured by trabecular bone score (TBS).

Methods

TBS and aBMD were evaluated at L1–L4 postero-anterior (PA) spine by dual X-ray absorptiometry (DXA) in 1520 men and women aged 40 years and over. Four hundred sixteen subjects who received GCs (≥5 mg/day, for ≥3 months) were matched with 1104 sex-, age-, and BMI-matched control subjects. Clinical data, osteoporotic fractures (OPF), and dietary habits were documented in the medical report.

Results

GC-treated patients were characterized by a significant decrease of TBS (1.267 vs. 1.298, p < 0.001) compared with control-matched subjects while no change in BMD was observed at any sites. These decreases were even more pronounced when fracture status was taken into account (1.222 vs. 1.298, p < 0.001). The odds ratio (OR) for TBS was 1.44 (1.095–1.89) for OPF, whereas no association was found for BMD at any sites (all p > 0.3). A similar effect on microarchitecture measured by TBS was seen by the presence of fracture as by the use of glucocorticoids. An influence on TBS by sex was also noted with a decrease in TBS of greater magnitude in men.

Conclusions

GC-treated individuals have a significant deterioration of bone microarchitectural texture as assessed by TBS which is more marked in those with OPF and in men. TBS seems to be more sensitive than aBMD for GC-related fracture detection and should be a good surrogate indicator of bone health in such secondary osteoporosis.

Van Staa TP, Leufkens HG, Abenhaim L, Zhang B, Cooper C (2000) Use of oral corticosteroids and risk of fractures. J Bone Miner Res 15(6):1487–1494

Canalis E, Mazziotti G, Giustina A, Bilezikian JP (2007) Glucocorticoid-induced osteoporosis: pathophysiology and therapy. Osteoporos Int 18(10):1319–1328PubMedCrossRef

Clowes JA, Peel N, Eastell R (2001) Glucocorticoid-induced osteoporosis. Curr Opin Rheumatol 13(4):326–332PubMedCrossRef

Spreafico A, Frediani B, Francucci CM, Capperucci C, Chellini F, Galeazzi M (2008) Role of apoptosis in osteoporosis induced by glucocorticoids. J Endocrinol Investig 31(7):22–27

Weinstein RS, Wan C, Liu Q, Wang Y, Almeida M et al (2010) Endogenous glucocorticoids decrease skeletal angiogenesis, vascularity, hydration, and strength in aged mice. Aging Cell 9(2):147–161PubMedPubMedCentralCrossRef

Dalle Carbonare L, Arlot ME, Chavassieux PM, Roux JP et al (2001) Comparison of trabecular bone microarchitecture and remodeling in glucocorticoid-induced and postmenopausal osteoporosis. J Bone Miner Res 16(1):97–103PubMedCrossRef

Manolagas SC, Weinstein RS (1999) New developments in the pathogenesis and treatment of steroid-induced osteoporosis. J Bone Miner Res 14(7):1061–1066PubMedCrossRef

Reid IR, Heap SW (1990) Determinants of vertebral mineral density in patients receiving long-term glucocorticoid therapy. Arch Intern Med 150(12):2545–2548PubMedCrossRef

Wetzsteon RJ, Shults J, Zemel BS, Gupta PU et al (2009) Divergent effects of glucocorticoids on cortical and trabecular compartment BMD in childhood nephrotic syndrome. J Bone Miner Res 24(3):503–513PubMedPubMedCentralCrossRef

10.

Hall GM, Spector TD, Griffin AJ, Jawad AS et al (1993) The effect of rheumatoid arthritis and steroid therapy on bone density in postmenopausal women. Arthritis Rheum 36(11):1510–1516PubMedCrossRef

11.

Saario R, Sonninen P, Möttönen T, Viikari J, Toivanen A (1999) Bone mineral density of the lumbar spine in patients with advanced rheumatoid arthritis. Influence of functional capacity and corticosteroid use. Scand J Rheumatol 28(6):363–367PubMedCrossRef

12.

Kanis JA, Johansson H, Oden A, Johnell O, de Laet C et al (2004) A meta-analysis of prior corticosteroid use and fracture risk. J Bone Miner Res 19(6):893–899PubMedCrossRef

13.

Naganathan V, Jones G, Nash P, Nicholson G et al (2000) Vertebral fracture risk with long-term corticosteroid therapy: prevalence and relation to age, bone density, and corticosteroid use. Arch Intern Med 160(19):2917–2922PubMedCrossRef

14.

Rehman Q, Lang T, Modin G, Lane NE (2002) Quantitative computed tomography of the lumbar spine, not dual x-ray absorptiometry, is an independent predictor of prevalent vertebral fractures in postmenopausal women with osteopenia receiving long-term glucocorticoid and hormone-replacement therapy. Arthritis Rheum 46(5):1292–1297PubMedCrossRef

15.

Van Staa TP, Laan RF, Barton IP, Cohen S et al (2003) Bone density threshold and other predictors of vertebral fracture in patients receiving oral glucocorticoid therapy. Arthritis Rheum 48(11):3224–3229PubMedCrossRef

16.

Schorlemmer S, Ignatius A, Claes L, Augat P (2005) Inhibition of cortical and cancellous bone formation in glucocorticoid-treated OVX sheep. Bone 37(4):491–496PubMedCrossRef

17.

Chappard D, Legrand E, Basle MF, Fromont P et al (1996) Altered trabecular architecture induced by corticosteroids: a bone histomorphometric study. J Bone Miner Res 11(5):676–685PubMedCrossRef

18.

LoCascio V, Ballanti P, Milani S, Bertoldo F et al (1998) A histomorphometric long-term longitudinal study of trabecular bone loss in glucocorticoid-treated patients: prednisone versus deflazacort. Calcif Tissue Int 62(3):199–204PubMedCrossRef

19.

Manolides AS, Cullen DM, Akhter MP (2010) Effects of glucocorticoid treatment on bone strength. J Bone Miner Metab 28(5):532–539PubMedCrossRef

20.

Winzenrieth R, Michelet F, Hans D (2013) 3D microarchitecture correlations with 2D projection image grey level variations assessed by TBS using high resolution CT acquisitions: effects of resolution and noise. J Clin Densitom 16(3):287–296PubMedCrossRef

21.

Hans D, Barthe N, Boutroy S, Pothuaud L, Winzenrieth R, Krieg MA (2011) Correlations between trabecular bone score, measured using anteroposterior dual-energy X-ray absorptiometry acquisition, and 3-dimensional parameters of bone microarchitecture: an experimental study on human cadaver vertebrae. J Clin Densitom 14(3):302–312PubMedCrossRef

22.

Romagnoli E, Cipriani C, Nofroni I, Castro C, Angelozzi M, Scarpiello A, Pepe J, Diacinti D, Piemonte S, Carnevale V, Minisola S (2013) “Trabecular bone score” (TBS): an indirect measure of bone micro-architecture in postmenopausal patients with primary hyperparathyroidism. Bone 53(1):154–159PubMedCrossRef

23.

Eller-Vainicher C, Filopanti M, Palmieri S, Ulivieri FM, Morelli V, Zhukouskaya V, Cairoli E, Pino R, Naccarato A, Verga U, Scillitani A, Beck-Peccoz P, Chiodini I (2013) Bone quality, as measured by trabecular bone score (TBS) in patients with primary hyperparathyroidism. Eur J Endocrinol 169(2):155–162PubMedCrossRef

24.

Bréban S, Briot K, Kolta S, Paternotte S, Ghazi M, Fechtenbaum J, Roux C (2012) Identification of rheumatoid arthritis patients with vertebral fractures using bone mineral density and trabecular bone score. J Clin Densitom 15(3):260–266PubMedCrossRef

25.

Dhaliwal R, Cibula D, Ghosh C, Weinstock RS, Moses AM (2014) Bone quality assessment in type diabetes mellitus. Osteoporos Int 25(7):1969–1973PubMedCrossRef

26.

Leslie WD, Aubry-Rozier B, Lamy O, Hans D (2013) Manitoba bone density program. TBS (trabecular bone score) and diabetes-related fracture risk. J Clin Endocrinol Metab 98(2):602–609PubMedCrossRef

27.

Eller-Vainicher C, Morelli V, Ulivieri FM, Palmieri S, Zhukouskaya VV, Cairoli E, Pino R, Naccarato A, Scillitani A, Beck-Peccoz P, Chiodini I (2012) Bone quality, as measured by trabecular bone score in patients with adrenal incidentalomas with and without subclinical hypercortisolism. J Bone Miner Res 27(10):2223–2230PubMedCrossRef

28.

Dempster DW (1983) Bone histomorphometry in glucocorticoid-induced osteoporosis. J Clin Densitom 4(2):137–141

29.

Angeli A, Guglielmi G, Dovio A, Capelli G et al (2006) High prevalence of asymptomatic vertebral fractures in post-menopausal women receiving chronic glucocorticoid therapy: a cross-sectional outpatient study. BONE 39(2):253–259PubMedCrossRef

30.

Habib GS, Haj S (2005) Bone mineral density in patients with early rheumatoid arthritis treated with corticosteroids. Clin Rheumatol 24(2):129–133PubMedCrossRef

31.

Hansen M, Floresco A, Stoltenberg M, Podenphant J et al (1996) Bone loss in rheumatoid arthritis. Influence of disease activity, duration of the disease, functional capacity and corticosteroid treatment. Scand J Rheumatol 25:367–376PubMedCrossRef

32.

Felder M, Ruegsegger P (1991) Bone loss in patients with rheumatoid arthritis—effect of steroids measured by low dose quantitative computed tomography. Rheumatol Int 1:41–44CrossRef

33.

van Everdingen AA, van Reesema DRS, Jacobs JW, Bijlsma JW (2003) Low-dose glucocorticoids in early rheumatoid arthritis: discordant effects on bone mineral density and fractures? Clin Exp Rheumatol 21(2):155–160PubMed

34.

Kaji H, Yamauchi M, Chihara K, Sugimoto T (2006) The threshold of bone mineral density for vertebral fracture in female patients with glucocorticoid-induced osteoporosis. Endocr J 53(1):27–34PubMedCrossRef

35.

Angeli A, Capelli G, deFeo D, Giustina A et al (2003) Age-related prevalence of vertebral deformities in post-menopausal women treated or untreated with glucocorticoids: a comparison between two national studies. J Clin Densitom 18(S2):360

36.

Graeff C, Marin F, Petto H, Kayser O, Reisinger A, Peña J, Zysset P, Glüer CC (2013) High resolution quantitative computed tomography-based assessment of trabecular microstructure and strength estimates by finite-element analysis of the spine, but not DXA, reflects vertebral fracture status in men with glucocorticoid-induced osteoporosis. Bone 52:568–577PubMedCrossRef

37.

Reid IR, France JT, Pybus J, Ibbertson HK (1985) Low plasma testosterone levels in glucocorticoid-treated male asthmatics. Br Med J 291:574CrossRef

38.

Hans D, Goertzen AL, Krieg MA, Leslie WD (2011) Bone microarchitecture assessed by TBS predicts osteoporotic fractures independent of bone density: the Manitoba study. J Bone Miner Res 26(11):2762–2769PubMedCrossRef

Title: Bone status in glucocorticoid-treated men and women
Authors: E. S. Leib
R. Winzenrieth
Publication date: 01-01-2016
Publisher: Springer London
Published in: Osteoporosis International / Issue 1/2016
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-015-3211-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Bone status in glucocorticoid-treated men and women

Abstract

Summary

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

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