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Long-term corticosteroid therapy induces mild changes in trabecular bone texture.

E Lespessailles1, V Siroux, S Poupon

  • 1Institut de Prevention et de Recherche sur l'Ostéoporose, Service de Rhumatologie, CHR, Orléans, France.

Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research
|April 26, 2000
PubMed
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Long-term corticosteroid therapy significantly reduces bone mineral density (BMD) and alters bone microarchitecture. While BMD shows a stronger effect, microarchitectural changes also contribute to corticosteroid-induced osteoporosis (CIOP).

Area of Science:

  • Osteoporosis Research
  • Bone Metabolism and Physiology
  • Radiology and Imaging Analysis

Background:

  • Corticosteroid-induced osteoporosis (CIOP) is a significant clinical concern, with ongoing debate regarding the relative contributions of bone mineral density (BMD) decrease and microarchitectural changes.
  • Understanding the specific impacts of corticosteroid (CS) therapy on bone health is crucial for developing effective prevention and treatment strategies.

Purpose of the Study:

  • To evaluate both bone microarchitecture, using fractal analysis of radiographs, and BMD in patients undergoing long-term corticosteroid therapy.
  • To compare the effects of CS therapy on bone mass and structure in patients with and without hormonal replacement therapy (HRT).

Main Methods:

  • Fractal analysis of trabecular bone texture was performed on calcaneus radiographs of 60 CS-treated patients and 57 controls, analyzing 18 directions using the fractional Brownian motion model.

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  • Bone mineral density (BMD) was measured at the femoral neck (FN) and lumbar spine (LS) using dual-energy X-ray absorptiometry (DEXA).
  • Odds ratios (OR) were calculated to assess the association between CS therapy and changes in BMD and fractal parameters (Hmean, Hmini, Hmaxi).

    • Main Results:

    • Corticosteroid therapy was significantly correlated with decreased BMD at both the femoral neck (OR=1.95) and lumbar spine (OR=3.19).
    • Fractal analysis revealed significantly lower Hmean (P=0.03) and Hmaxi (P=0.02) in CS-treated patients compared to controls, indicating altered bone texture.
    • The impact of CS therapy was more pronounced on BMD than on fractal parameters, although microarchitectural changes were statistically significant.

    Conclusions:

    • Long-term corticosteroid therapy induces both a decrease in bone mineral density and changes in trabecular bone texture.
    • While BMD reduction is a primary effect, microarchitectural alterations also play a role in corticosteroid-induced osteoporosis.
    • The findings suggest that CS therapy's effect on bone microarchitecture may be less pronounced than on bone mass, contrasting with postmenopausal osteoporosis.