Bone Ultrasonography in Glucocorticoid-induced Osteoporosis

Overview

Journal Osteoporos Int

Specialties Endocrinology
Orthopedics

Date 2004 Oct 2

PMID 15459804

Citations 3

Authors

C Cepollaro

S Gonnelli

P Rottoli

A Montagnani

C Caffarelli

D Bruni

N Nikiforakis

A Fossi

S Rossi

R Nuti

Affiliations

Soon will be listed here.

Abstract

Osteoporosis is one of the major complications of glucocorticoid (GC) therapy. Few data are available on the usefulness of quantitative ultrasound (QUS), a technique that could also theoretically provide information on bone structure, in the management of glucocorticoid-induced osteoporosis (GIO). This study aimed (1) to evaluate the ability of QUS in detecting bone impairment and in being associated with the prevalence of fragility fracture in GC patients; and (2) to assess whether QUS parameters, and particularly the graphic trace analysis of QUS signal at phalanges, show any peculiar pattern of GIO. We studied 192 patients (136 women and 56 men, mean age 56.7 +/- 14.2 years) on treatment with GCs for at least 6 months, and 192 sex- and age-matched controls. In all subjects, we measured bone mineral density (BMD) at lumbar spine and at femur by DXA, and ultrasound parameters at calcaneus and phalanges. All DXA and QUS parameters were significantly lower in GC patients than in controls and in fracture than in nonfracture GC patients. BMD at lumbar spine showed the best ability in discriminating GC patients with or without fractures. Among QUS parameters, stiffness showed a discriminatory ability significantly better than AD-SoS. BMD at lumbar spine and total femur, stiffness, and AD-SoS are able to predict the odds of fragility fracture event. QUS parameters of the postmenopausal GC patients (n = 105) and of the postmenopausal healthy controls (n = 101) were also compared with those obtained in a separate sample of 90 postmenopausal osteoporotic women (PMO). All parameters were significantly lower in GC patients and in PMO than in controls, without any significant difference between GC and PMO. Our findings show that QUS can be useful in the assessment of glucocorticoid-induced bone impairment. In addition, in this study we found no alteration in QUS parameters or in the graphic trace analysis which could differentiate between GIO and PMO. Further longitudinal studies are needed to define the role of QUS in the prediction of fracture risk and in the clinical management of GIO.

Citing Articles

The ability of calcaneal and multisite quantitative ultrasound variables in the identification of osteoporosis in women and men.

Oral A, Esmaeilzadeh S, Yaliman A, Sindel D, Kursuz Koseoglu P, Aydin T Turk J Phys Med Rehabil. 2019; 65(3):203-215.

PMID: 31663068 PMC: 6797920. DOI: 10.5606/tftrd.2019.1894.

Cross-sectional study on bone density-related sonographic parameters in children with asthma: correlation to therapy with inhaled corticosteroids and disease severity.

Mainz J, Sauner D, Malich A, John S, Beyermann H, Mentzel H J Bone Miner Metab. 2008; 26(5):485-92.

PMID: 18758907 DOI: 10.1007/s00774-008-0860-6.

Increased bone fracture prevalence in postmenopausal women suffering from pollen-allergy.

Ferencz V, Meszaros S, Csupor E, Toth E, Bors K, Falus A Osteoporos Int. 2006; 17(3):484-91.

PMID: 16432646 DOI: 10.1007/s00198-005-0011-z.

References

Kos-Kudla B, Pluskiewicz W . Quantitative ultrasound of the heel and serum and urinary cortisol values in assessment of long-term corticotherapy side effects in female bronchial asthma patients. Ultrasound Med Biol. 1997; 23(9):1325-30. DOI: 10.1016/s0301-5629(97)00195-6. View

Hanley J, McNeil B . A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology. 1983; 148(3):839-43. DOI: 10.1148/radiology.148.3.6878708. View

Luengo M, Picado C, Del Rio L, Guanabens N, Montserrat J, Setoain J . Vertebral fractures in steroid dependent asthma and involutional osteoporosis: a comparative study. Thorax. 1991; 46(11):803-6. PMC: 1021033. DOI: 10.1136/thx.46.11.803. View

van Staa T, Leufkens H, Abenhaim L, Zhang B, Cooper C . Use of oral corticosteroids and risk of fractures. J Bone Miner Res. 2000; 15(6):993-1000. DOI: 10.1359/jbmr.2000.15.6.993. View

Sambrook P, Raj A, Hunter D, Naganathan V, Mason R, Robinson B . Osteoporosis with low dose corticosteroids: contribution of underlying disease effects and discriminatory ability of ultrasound versus bone densitometry. J Rheumatol. 2001; 28(5):1063-7. View

Sinigaglia L, Nervetti A, Mela Q, Bianchi G, del Puente A, Di Munno O . A multicenter cross sectional study on bone mineral density in rheumatoid arthritis. Italian Study Group on Bone Mass in Rheumatoid Arthritis. J Rheumatol. 2000; 27(11):2582-9. View

Peel N, Moore D, Barrington N, Bax D, Eastell R . Risk of vertebral fracture and relationship to bone mineral density in steroid treated rheumatoid arthritis. Ann Rheum Dis. 1995; 54(10):801-6. PMC: 1010013. DOI: 10.1136/ard.54.10.801. View

Dalle Carbonare L, Arlot M, Chavassieux P, Roux J, Portero N, Meunier P . Comparison of trabecular bone microarchitecture and remodeling in glucocorticoid-induced and postmenopausal osteoporosis. J Bone Miner Res. 2001; 16(1):97-103. DOI: 10.1359/jbmr.2001.16.1.97. View

Rubin M, Bilezikian J . Clinical review 151: The role of parathyroid hormone in the pathogenesis of glucocorticoid-induced osteoporosis: a re-examination of the evidence. J Clin Endocrinol Metab. 2002; 87(9):4033-41. DOI: 10.1210/jc.2002-012101. View

10.

Reid I . Glucocorticoid effects on bone. J Clin Endocrinol Metab. 1998; 83(6):1860-2. DOI: 10.1210/jcem.83.6.4911. View

11.

Javaid M, McCrudden P, Taylor P, Petley G, Stroud M, Fine D . Comparison of calcaneal ultrasound and DXA to assess the risk of corticosteroid-induced osteoporosis: a cross-sectional study. Osteoporos Int. 2001; 12(9):788-93. DOI: 10.1007/s001980170056. View

12.

van Staa T, Leufkens H, Cooper C . The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis. Osteoporos Int. 2002; 13(10):777-87. DOI: 10.1007/s001980200108. View

13.

Blanckaert F, Cortet B, Coquerelle P, Flipo R, Duquesnoy B, Marchandise X . Contribution of calcaneal ultrasonic assessment to the evaluation of postmenopausal and glucocorticoid-induced osteoporosis. Rev Rhum Engl Ed. 1997; 64(5):305-13. View

14.

Tauchmanova L, Rossi R, Nuzzo V, del Puente A, Esposito-Del Puente A, Pizzi C . Bone loss determined by quantitative ultrasonometry correlates inversely with disease activity in patients with endogenous glucocorticoid excess due to adrenal mass. Eur J Endocrinol. 2001; 145(3):241-7. DOI: 10.1530/eje.0.1450241. View

15.

Montagnani A, Gonnelli S, Cepollaro C, Bruni D, Franci M, Lucani B . Graphic trace analysis of ultrasound at the phalanges may differentiate between subjects with primary hyperparathyroidism and with osteoporosis: a pilot study. Osteoporos Int. 2002; 13(3):222-7. DOI: 10.1007/s001980200018. View

16.

Njeh C, Fuerst T, Diessel E, Genant H . Is quantitative ultrasound dependent on bone structure? A reflection. Osteoporos Int. 2001; 12(1):1-15. DOI: 10.1007/PL00020939. View

17.

Gluer C . Quantitative ultrasound techniques for the assessment of osteoporosis: expert agreement on current status. The International Quantitative Ultrasound Consensus Group. J Bone Miner Res. 1997; 12(8):1280-8. DOI: 10.1359/jbmr.1997.12.8.1280. View

18.

Flohr F, Lutz A, App E, Matthys H, Reincke M . Bone mineral density and quantitative ultrasound in adults with cystic fibrosis. Eur J Endocrinol. 2002; 146(4):531-6. DOI: 10.1530/eje.0.1460531. View

19.

Hans D, Dargent-Molina P, Schott A, Sebert J, Cormier C, Kotzki P . Ultrasonographic heel measurements to predict hip fracture in elderly women: the EPIDOS prospective study. Lancet. 1996; 348(9026):511-4. DOI: 10.1016/s0140-6736(95)11456-4. View

20.

Wuster C, Albanese C, de Aloysio D, Duboeuf F, Gambacciani M, Gonnelli S . Phalangeal osteosonogrammetry study: age-related changes, diagnostic sensitivity, and discrimination power. The Phalangeal Osteosonogrammetry Study Group. J Bone Miner Res. 2000; 15(8):1603-14. DOI: 10.1359/jbmr.2000.15.8.1603. View