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Bone Geometry, Volumetric Bone Mineral Density, Microarchitecture and Estimated Bone Strength in Caucasian Females with Systemic Lupus Erythematosus. A Cross-Sectional Study Using HR-pQCT

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Abstract

Patients with systemic lupus erythematosus (SLE) have an increased risk of fracture. We used high resolution peripheral quantitative computed tomography (HR-pQCT) to measure bone geometry, volumetric bone mineral density (vBMD), cortical and trabecular microarchitecture and estimated bone strength by finite element analysis (FEA) at the distal radius and tibia to assess bone characteristics beyond BMD that may contribute to the increased risk of fracture. Thirty-three Caucasian women with SLE (median age 48, range 21–64 years) and 99 controls (median age 45, range 21–64 years) were studied. Groups were comparable in radius regarding geometry and vBMD, but SLE patients had lower trabecular number (−7 %, p < 0.05), higher trabecular separation (13 %, p < 0.05) and lower FEA-estimated failure load compared to controls (−10 %, p < 0.05). In tibia, SLE patients had lower total vBMD (−11 %, p < 0.01), cortical area (−14 %, p < 0.001) and cortical thickness (−16 %, p < 0.001) and higher trabecular area (8 %, p < 0.05). In subgroup analyses of the premenopausal participants (SLE n = 21, controls n = 63), SLE patients had significantly lower trabecular bone volume fraction [(BV/TV); −17 %, p < 0.01], trabecular number (−9 %, p < 0.01), trabecular thickness (−9 %, p < 0.05) and higher trabecular separation (13 %, p < 0.01) and trabecular network inhomogeneity (14 %, p < 0.05) in radius along with lower BV/TV (−15 %, p < 0.01) and higher trabecular separation (11 %, p < 0.05) in tibia. FEA-estimated bone strength was lower in both radius (−11 %, p < 0.01) and tibia (−10 %, p < 0.05). In conclusion, Caucasian women with SLE compared to controls had fewer and more widely separated trabeculae and lower estimated bone strength in radius and lower total vBMD, cortical area and thickness in tibia.

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Acknowledgments

The authors wish to thank Elsebeth Byrge for managing study logistics, and the technicians at the Osteoporosis Clinic, Odense University Hospital, for excellent technical support. Kim Brixen has received research support from Merck Sharpe & Dohme, Amgen Inc., Novartis and NPS Pharmaceuticals, served as a consultant for Merck Sharpe & Dohme and speaker for Servier, Amgen Inc., GlaxoSmithKline and Novartis.

Conflict of interest

Stinus Hansen, Claire Gudex, Fabian Åhrberg and Anne Voss state that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

The study was approved by the Regional Scientific Ethical Committee for Southern Denmark. All participants provided informed consent. The study did not involve experimental animals.

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Authors and Affiliations

  1. Department of Endocrinology, Odense University Hospital, Kloevervaenget 6.1.sal, 5000, Odense C, Denmark

    Stinus Hansen, Claire Gudex, Fabian Åhrberg & Kim Brixen

  2. Institute of Clinical Research, University of Southern Denmark, Winsløwparken 19, 5000, Odense, Denmark

    Stinus Hansen, Claire Gudex & Kim Brixen

  3. Department of Rheumatology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark

    Anne Voss

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  1. Stinus Hansen
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Correspondence to Stinus Hansen.

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Hansen, S., Gudex, C., Åhrberg, F. et al. Bone Geometry, Volumetric Bone Mineral Density, Microarchitecture and Estimated Bone Strength in Caucasian Females with Systemic Lupus Erythematosus. A Cross-Sectional Study Using HR-pQCT. Calcif Tissue Int 95, 530–539 (2014). https://doi.org/10.1007/s00223-014-9918-8

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  • DOI: https://doi.org/10.1007/s00223-014-9918-8

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