Bone Mass, Microstructure, and Strength Can Discriminate Vertebral Fracture in Patients on Long-Term Steroid Treatment.

Abstract

Context:

Measurement of areal bone mineral density (aBMD) by dual-energy x-ray absorptiometry (DXA) was able to predict fracture risk. High-resolution peripheral quantitative computed tomography (HR-pQCT) yields additional information about volumetric bone mineral density (vBMD), microarchitecture, and strength that may increase our understanding of fracture susceptibility.

Objective:

To ascertain whether vBMD, microarchitecture, and estimated bone strength derived from HR-pQCT can discriminate vertebral fractures in patients with glucocorticoid-induced osteoporosis (GIOP) independent of aBMD.

Design:

A cross-sectional case-control study.

Setting:

Seven regional hospitals in Hong Kong.

Patients:

A total of 110 patients on long-term glucocorticoids with vertebral fracture, determined radiographically, and 110 patients on long-term glucocorticoids without fracture.

Main Outcome Measures:

We assessed vBMD, microarchitecture, and bone strength; aBMD; and fracture risk assessment tool (FRAX).

Results:

Patients with vertebral fracture had lower total vBMD and a thinner cortex at the distal tibia after adjustment for age, sex, and aBMD or FRAX. In the antiresorptive treatment-naive subgroup, patients with vertebral fracture also had lower total vBMD at both the distal radius and the tibia after adjustment for covariates. Lower total vBMD and a thinner cortex were also noticed in the nonosteoporotic or FRAX score of <10% subgroups with vertebral fracture and were also associated with increasing prevalence of vertebral fracture.

Conclusion:

Patients with GIOP and vertebral fracture have a significant reduction in total vBMD and cortical thinning independent of aBMD and FRAX. These changes may help identify high-risk patients in the subgroups currently considered to have low fracture risk as assessed by DXA or FRAX.

• Authors: Jiayun Shen, James F Griffith, Tracy Y Zhu, Peggy Tang, Emily W Kun, Violet K Lee, Ronald M Yip, Kitty Y Kwok, Shirley K Ying, Carmen T Ho, Sze-Lok Lau, Michelle O Pui, Tena K Li, Eleven Y Lau, Jack J Lee, Ling Qin, Lai-Shan Tam
• Journal: The Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 103 Issue 9 Pg. 3340-3349 (09 01 2018) ISSN: 1945-7197 [Electronic] United States
• PMID: 29982545 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Glucocorticoids

Topics

• Absorptiometry, Photon
• Adult
• Aged
• Bone Density
• Case-Control Studies
• Cortical Bone (diagnostic imaging, physiopathology)
• Cross-Sectional Studies
• Female
• Glucocorticoids (adverse effects)
• Hong Kong
• Humans
• Male
• Middle Aged
• Osteoporosis (chemically induced, complications, physiopathology)
• Prevalence
• Radius (diagnostic imaging, physiopathology)
• Risk Factors
• Spinal Fractures (epidemiology, etiology)
• Tibia (diagnostic imaging, physiopathology)
• Time Factors
• Tomography, X-Ray Computed (methods)