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Multidetector-row computed tomography is useful to evaluate the therapeutic effects of bisphosphonates in glucocorticoid-induced osteoporosis

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Abstract

Osteoporosis is one of the major complications of glucocorticoid therapy. Osteoporosis is usually defined by the levels of bone mineral density (BMD) assessed by dual energy X-ray absorptiometry (DEXA); however, glucocorticoids often induce fractures in patients with normal BMD. Thus, novel diagnostic approaches are required. In this study, we examined whether multidetector-row computed tomography (MDCT) is useful to assess the bone status in glucocorticoid-induced osteoporosis (GIO). Because bisphosphonates have been proven to prevent bone fracture in GIO, we tried to detect the therapeutic effects of bisphosphonates in GIO by MDCT. Fifteen Japanese patients with immunoglobulin A nephropathy who had normal renal function were enrolled in this open-label randomized trial. Patients were randomly divided into three groups—calcitriol (VD), menatetrenone (VK), or bisphosphonate (Bis). Bone conditions were analyzed twice by three different methods—bone turnover markers, DEXA, and MDCT—at the start and 6 months after the start of therapy. Both bone markers and DEXA could not detect significant differences among the therapeutic groups; however, MDCT-based analyses detected the preventive effects of bisphosphonates in GIO. Compared to VD, Bis improved structural indices, such as bone volume fraction, trabecular separation, marrow star volume, and structure model index whereas the difference between VD and VK was not significant. Finite element analysis revealed that simulated fracture load in the Bis group was significantly improved. These findings suggested that MDCT-based assessment is superior to bone markers and/or DEXA in assessing the therapeutic effect of bisphosphonates on GIO.

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Acknowledgments

This research was supported by a grant from The Kidney Foundation Japan (JKFB08-7), ROD-21 research foundation (to T Hamano), and Eisai Co., Ltd. (Tokyo, Japan).

Conflict of interest

This research was supported by a grant from Eisai Co., Ltd. (Tokyo, Japan), which sells risedronate in Japan. We have full control of all primary data. We agree to allow the journal to review our primary data if requested. This research was planned by T. Hamano, K. Tomida, S. Mikami, and N. Fujii. All data were analyzed by K. Inoue, N. Nango, K Tomida, and S. Mikami. This manuscript was prepared by K. Inoue, N. Nango, I. Matsui, and T. Hamano. All the procedures were supervised by H. Rakugi, Y. Isaka, and Y. Tsubakihara.

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Authors and Affiliations

  1. Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan

    Kazunori Inoue, Isao Matsui, Chikako Nakano, Yoshitsugu Obi, Akihiro Shimomura, Yasuo Kusunoki, Hiromi Rakugi & Yoshitaka Isaka

  2. Department of Comprehensive Kidney Disease Research, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan

    Takayuki Hamano & Yoshiharu Tsubakihara

  3. Ratoc System Engineering Co., Ltd, Toho Edogawabashi Building 4th Floor, 1-24-8 Sekiguchi, Bunkyo-ku, Tokyo, 112-0014, Japan

    Nobuhito Nango

  4. Department of Nephrology and Hypertension, Osaka General Medical Center, 3-1-56 Mandaihigashi, Osaka, 558-0056, Japan

    Kodo Tomida

  5. Department of Internal Medicine, Higashikohri Hospital, 1-24-34 Higashikohri, Hirakata, Osaka, 573-0075, Japan

    Satoshi Mikami

  6. Department of Internal Medicine, Hyogo Prefectural Nishinomiya Hospital, 13-9 Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan

    Naohiko Fujii

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  1. Kazunori Inoue
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  2. Takayuki Hamano
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  7. Naohiko Fujii
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  9. Yoshitsugu Obi
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  10. Akihiro Shimomura
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  13. Yoshitaka Isaka
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  14. Yoshiharu Tsubakihara
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Corresponding author

Correspondence to Takayuki Hamano.

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Inoue, K., Hamano, T., Nango, N. et al. Multidetector-row computed tomography is useful to evaluate the therapeutic effects of bisphosphonates in glucocorticoid-induced osteoporosis. J Bone Miner Metab 32, 271–280 (2014). https://doi.org/10.1007/s00774-013-0485-2

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  • DOI: https://doi.org/10.1007/s00774-013-0485-2

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