Postmenopausal Canarian women receiving oral glucocorticoids have an increased prevalence of vertebral fractures and low values of bone mineral density measured by quantitative computer tomography and dual X-ray absorptiometry, without significant changes in parathyroid hormone

Sosa, M.; Jódar, E.; Saavedra, P.; Navarro, M.C.; Gómez de Tejada, M.J.; Martín, A.; Peña, P.; Gómez, J.

doi:10.1016/j.ejim.2007.08.005

« Previous Next »European Journal of Internal Medicine
Volume 19, Issue 1 , Pages 51-56, January 2008

Postmenopausal Canarian women receiving oral glucocorticoids have an increased prevalence of vertebral fractures and low values of bone mineral density measured by quantitative computer tomography and dual X-ray absorptiometry, without significant changes in parathyroid hormone

M. Sosa
- University Hospital Insular, Department of Internal Medicine, Bone Metabolic Unit, University of Las Palmas de Gran Canaria, Investigation Group on Osteoporosis, Canary Islands, Spain
- Corresponding author. University of Las Palmas de Gran Canaria, Investigation Group on Osteoporosis, Faculty of Medicine, Apartado 550, 35080, Las Palmas de Gran Canaria, Canary Islands, Spain. Tel.: +34 928451456; fax: +34 928451428.
E. Jódar
- University Hospital 12 de Octubre, Endocrinology Division, Metabolic Bone Diseases Unit, Madrid, Spain
P. Saavedra
- University of Las Palmas de Gran Canaria, Spain
M.C. Navarro
- University of Las Palmas de Gran Canaria, Spain
M.J. Gómez de Tejada
- University of Seville, Department of Medicine, Seville, Spain
A. Martín
- University Hospital Insular, Department of Internal Medicine, Bone Metabolic Unit, University of Las Palmas de Gran Canaria, Investigation Group on Osteoporosis, Canary Islands, Spain
P. Peña
- University Hospital Insular, Department of Internal Medicine, Bone Metabolic Unit, University of Las Palmas de Gran Canaria, Investigation Group on Osteoporosis, Canary Islands, Spain
J. Gómez
- University Hospital Insular, Department of Internal Medicine, Bone Metabolic Unit, University of Las Palmas de Gran Canaria, Investigation Group on Osteoporosis, Canary Islands, Spain

Received 17 December 2006; received in revised form 28 August 2007; accepted 30 August 2007. published online 22 November 2007.

Abstract

Background

Daily doses higher than 7.5 mg/daily of prednisone or equivalents confer a great risk of vertebral and hip fractures with a clear dose dependence of fracture risk. Information regarding the utility in assessing trabecular bone mineral density by quantitative computer tomography (QCT) in these patients, either in the Canaries or in Spain, is lacking. Moreover, in this setting, the importance of secondary hyperparathyroidism is still controversial.

Design, patients and methods

Cross-sectional observational study performed on 1177 consecutive Canary postmenopausal women who attended our Bone Metabolic Unit. The Patient Group was composed of 88 postmenopausal women who were taking oral corticosteroids in dose higher than 7.5 mg/day of prednisone or equivalent for more than 6 months (OG group). The Control Group included 838 postmenopausal women who did not take steroids. A complete validated questionnaire for osteoporosis risk assessment and a complete physical examination were performed. A lateral X-ray of the spine was performed on every woman. Bone mineral density (BMD) was measured at the lumbar spine (LS) by dual X-ray Absorptiometry (DXA) and QCT and at the femoral neck by DXA. Fasting serum and 24 hour urine was collected and biochemical markers of bone remodelling were studied.

Results

Both groups were comparable in general characteristics and calcium intake. The OG group showed lower values of BMD estimated both by DXA and QCT (p<0.05). LS BMD was closely correlated by using both methods (r=0.636, p<0.001). The OG group showed lower values of osteocalcin (p=0.023) and TRAP (p=0.026) without significant differences in PTH. Patients in OG group had a higher prevalence of vertebral fractures than controls (13.3% vs 8.6%; crude values: p=0.049, OR: 1.63 (0.99–2.67); age adjusted: p=0.003, OR 2.29 (1.33–9.93)).

Conclusions

In postmenopausal Canarian women, chronic glucocorticoid therapy is associated with low bone mineral density, measured either by DXA or QCT, with evidence of low turnover and high prevalence of fractures without significant changes in PTH. DXA and QCT provide similar information in the assessment of this high risk population.

Keywords: Glucocorticoids, Fractures, Bone mineral density, Bone turnover, Osteoporosis, DXA, QCT, Osteocalcin, TRAP, PTH, Canary Island, Postmenopausal women