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The impact of glucocorticoid therapy on trabecular bone score in older women

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Abstract

Summary

We propose that trabecular bone score could be a useful tool for the study of glucocorticoid-associated bone effects. Trabecular bone score alone and lumbar spine bone mineral density (BMD) used in combination with trabecular bone score, but not lumbar spine BMD alone was able to discriminate between glucocorticoid-treated and glucocorticoid-naïve women.

Introduction

Glucocorticoids result in rapid bone loss and an increase in fracture risk that cannot be fully explained by changes in BMD. Trabecular bone score (TBS) correlates with three-dimensional bone micro-architectural parameters and can be derived from grey-level variations within dual energy X-ray absorptiometry (DXA) scans. We propose that TBS could be a useful tool for the study of glucocorticoid-associated bone effects.

Methods

We assessed the ability of lumbar spine BMD (LS-BMD), TBS, and LS-BMD with TBS (LS-BMD + TBS) to discriminate between healthy women and (i) glucocorticoid-treated women, and (ii) glucocorticoid-naïve women with recent fractures. Older women (n = 484, ages 55–79 years) who had (i) taken prednisolone ≥5 mg/day for >3 months (n = 64), (ii) sustained a recent fracture of the distal forearm (n = 46), proximal humerus (n = 37), vertebra (n = 30) or proximal femur (n = 28), or (iii) were healthy population-based women (n = 279) were recruited. LS-BMD was measured by DXA and TBS values were derived.

Results

Compared to healthy, population-based women, women with recent fractures had lower LS-BMD (−0.34 to −1.38) and TBS (−0.38 to −1.04) Z-scores. Glucocorticoid-treated women had lower TBS Z-scores than glucocorticoid-naïve women (−0.80 versus 0) but their LS-BMD Z-scores did not differ (−0.13 versus 0). TBS alone (area under the receiver operating characteristic curve (AUC) = 0.721) and LS-BMD + TBS (AUC = 0.721), but not LS-BMD alone (AUC = 0.572) was able to discriminate between glucocorticoid-treated and glucocorticoid-naïve women.

Conclusions

TBS provides additional information regarding glucocorticoid-associated alterations in bone quality. We conclude that TBS may be a useful tool for the further study of glucocorticoid-induced osteoporosis.

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Acknowledgments

This study was funded by Eli Lilly, Sanofi-Aventis, Procter & Gamble Pharmaceuticals, Hoffman-La Roche, Pfizer, Novartis and the National Osteoporosis Society (NOS). The funders were involved in the design, but not in the conduct, analysis or reporting of the study. We kindly acknowledge Medimaps (Pessac, France) for providing the TBS software, and Professor Didier Hans for his continued support. We also thank the staff of the Academic Unit of Bone Metabolism and all our study participants. The authors have approved the manuscript for publication and vouch for the completeness and accuracy of the data.

RE has received grant funding from Procter and Gamble Pharmaceuticals, Eli Lilly, Sanofi-Aventis, Hoffman-La Roche, Pfizer, Novartis and the National Osteoporosis Society; consultancy fees from Eli Lilly, Pfizer, Sanofi-Aventis and Novartis; lecture fees from Eli Lilly; and served on the advisory boards of Procter and Gamble Pharmaceuticals and Eli Lilly.

Conflicts of interest

MAP, NFAP and RE have no conflicts of interest. MAP has received a travel grant from Medimaps. NFAP has received speaker’s honoraria from Eli Lilly and Procter and Gamble Pharmaceuticals, research funding from the National Osteoporosis Society and consultancy fees from Eli Lilly and Procter and Gamble Pharmaceuticals.

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Correspondence to M. A. Paggiosi.

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Paggiosi, M.A., Peel, N.F.A. & Eastell, R. The impact of glucocorticoid therapy on trabecular bone score in older women. Osteoporos Int 26, 1773–1780 (2015). https://doi.org/10.1007/s00198-015-3078-1

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  • DOI: https://doi.org/10.1007/s00198-015-3078-1

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