Abnormalities in cortical bone, trabecular plates, and stiffness in postmenopausal women treated with glucocorticoids

Abstract

Context: The mechanisms by which glucocorticoids (GCs) increase skeletal fragility are not well understood. Objective: The objective of the study was to evaluate the microarchitecture, trabecular morphology, and biomechanical properties of bone in postmenopausal women treated with GCs. Design: This was a case-control study. Setting: The study was conducted at a university hospital outpatient facility. Patients: Postmenopausal women treated with oral GCs for longer than 3 months (n= 30) and age/race-matched controls (n= 60) participated in the study. Main Outcome Measures: Areal bone mineral density aBMD (BMD) by dual-energy x-ray absorptiometry (DXA) was measured. Trabecular and cortical volumetric BMD (vBMD) and microarchitecture byhigh-resolution peripheralcomputedtomographyof the distal radiusandtibiawerealso measured. Whole-bone stiffness was estimated by finite element analysis. Anovel technique, individual trabecula segmentation, was used to evaluate trabecular type (as plate or rod), orientation, and connectivity. Results: DXA T-scores did not differ significantly at any site. GC subjects had significantly lower total, cortical, and trabecular vBMD and thinner cortices, fewer, thinner, more widely, and irregularly spaced trabeculae. They had fewer trabecular plates, fewer axially aligned trabeculae, and lower trabecular connectivity. Differences ranged from 4% to 65% for these trabecular measures and5%to17%for the cortical measures. Whole-bone stiffness was significantly lower (11%-16%) in GC subjects. Markers of bone formation (osteocalcin and amino-terminal propeptide of type I procollagen) and resorption (C-telopeptide) were lower in the GC subjects. Conclusions: Despite similar areal BMD by DXA, GC-treated women had abnormal cortical and trabecular vBMD and microarchitecture at both the radius and tibia, including fewer trabecular plates, a less axially aligned trabecular network, lower trabecular connectivity, thinner cortices, and lower whole-bone stiffness. Further research into these abnormalities as mechanisms for fracture in GC-treated women is warranted.