Increased reduction in bone density and skin thickness in postmenopausal women on long term corticosteroid therapy: A suggested role for estrogen add back therapy

Abstract

Background: Long term steroid therapy is complicated by osteoporosis and generalised thinning of the skin. These two complications of long term corticosteroid therapy were routinely assessed at the Menopause Clinic of St. Luke's Hospital, Medical School, University of Malta. Methods: A cross sectional study was performed on 64 postmenopausal women who had been on long term corticosteroids. Each woman had her skin thickness measured using high resolution ultrasound (22mhz) and their bone density measured using a DEXA Norland. These measurements were compared to a control group (n=557), a group of women who had sustained osteoporotic fractures (n=180), and a group of women on hormone replacement therapy (HRT) (n=399). A longitudinal study on 29 postmenopausal women on corticosteroids was also performed. In this study results were compared between women who in addition to their corticosteroids were on HRT and those who were on corticosteroids alone. Results: The cross sectional study showed the corticosteroid therapy was associated with the thinnest skin thickness measurements mean 0.83mm. Similarly, low bone density measurements lumbar spine mean 0.81 g/cm2 and left hip mean 0.71 g/cm2 were obtained for this group. The skin thickness in controls and in the HRT groups had a mean thickness of 0.93mm while that of the osteoporotic fracture group was 0.88mm. The bone density of the osteoporotic fractures in the fracture group was similar to that of group of women on long term corticosteroids. The lumbar spine had a mean density of 0.81 g/cm2 and left hip that of 0.71g/cm2. The bone density of the control group and HRT group was significantly higher. The lumbar spine had a mean density of 0.93g/cm2 and that of left hip was 0.82g/cm2. The small longitudinal study compared postmenopausal women on long term corticosteroid therapy on HRT to another group who was not on HRT. The longitudinal study over four years revealed a constant increase in skin thickness (mean 6% per year) and bone density (left hip mean 5% per year, lumbar spine mean 5% per year). Conclusion: In postmenopausal women on long term corticosteroids, skin thickness and bone density were both decreased, but the addition of HRT as add back improved the situation dramatically. Skin thickness and bone density level in women on long term corticosteroids were comparable to that of women who had sustained osteoporotic fractures. It is therefore suggested that HRT be used as add back therapy in postmenopausal women on long term corticosteroid therapy.