Osteoporosis International

, Volume 17, Issue 4, pp 627–633 | Cite as

Body composition and vertebral fracture risk in female patients treated with glucocorticoid

  • H. Kaji
  • T. Tobimatsu
  • J. Naito
  • M.-F. Iu
  • M. Yamauchi
  • T. Sugimoto
  • K. Chihara
Original Article

Abstract

Introduction

Glucocorticoid (GC) causes bone loss and an increase in bone fragility. However, fracture risk was found to be only partly explained by bone mineral density in GC-treated patients (GC patients). Although GC causes a change in the distribution of fat in the body, the relationship between body composition and fracture risk in GC patients remains unknown.

Methods

The present study examined the relationship between the presence or absence of vertebral fractures and various indices, including body composition, in 92 premenopausal GC patients, 122 postmenopausal GC patients and 122 postmenopausal age-matched control subjects. Dual-energy X-ray absorptiometry was employed to analyze body composition.

Results

Percentage lean body mass (LBM), % fat and % trunk fat were not significantly different between postmenopausal GC patients and the control women. When groups with and without vertebral fractures were compared, % LBM and % fat were significantly higher and lower in groups with vertebral fractures, respectively, in postmenopausal GC patients, but not in the postmenopausal control women, although % trunk fat was not significantly different between groups with and without vertebral fractures. Femoral neck BMD was negatively correlated with % LBM and positively correlated with % fat. In premenopausal GC patients, % trunk fat was significantly higher in the fracture group, although % LBM and % fat were not significantly different between groups with and without vertebral fractures.

Conclusion

The present study revealed that body composition is related to vertebral fracture risk in GC-treated patients. Lower % fat can be included in the determination of vertebral fractures in postmenopausal GC-treated patients. The influence of body composition on vertebral fracture risk may be different between the pre- and postmenopausal state in GC patients.

Keywords

Body composition Fracture Glucocorticoid Osteoporosis 

References

  1. 1.
    Ross EJ, Linch DC (1982) Cushing's syndrome-killing disease: discriminatory value of signs and symptoms aiding early diagnosis. Lancet 2:646–649CrossRefPubMedGoogle Scholar
  2. 2.
    Adinoff AD, Hollister JR (1983) Steroid-induced fractures and bone loss in patients with asthma. N Engl J Med 309:265–268PubMedCrossRefGoogle Scholar
  3. 3.
    Van Staa TP, Leufkens HG, Abenhaim L, Zhang B, Cooper C (2000) Use of oral corticosteroids and risk of fractures. J Bone Miner Res 15:993–1000PubMedCrossRefGoogle Scholar
  4. 4.
    Steinbuch M, Youket TE, Cohen S (2004) Oral glucocorticoid use is associated with an increased risk of fracture. Osteoporos Int 15:323–328CrossRefPubMedGoogle Scholar
  5. 5.
    Luengo M, Picado C, Del Rio L, Guanabens N, Montserrat JM, Setoain J (1991) Vertebral fractures in steroid dependent asthma and involutional osteoporosis: a comparative study. Thorax 46:803–806PubMedCrossRefGoogle Scholar
  6. 6.
    Van Staa TP, Leufkens HG, Cooper C (2002) The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis. Osteoporos Int 13:777–787CrossRefPubMedGoogle Scholar
  7. 7.
    Kanis JA, Johansson H, Oden Am Johnell O, de Laet C, Melton III LJ, Tenenhouse A, Reeve J, Silman AJ, Pols HAP, Eisman JA, McCloskey EV, Mellstrom D (2004) A meta-analysis of prior corticosteroid use and fracture risk. J Bone Miner Res 19:893–899PubMedCrossRefGoogle Scholar
  8. 8.
    Sambrook P, Birmingham J, Kempler S, Kelly P, Eberl S, Pecock N, Yeates M, Eisman J (1990) Corticosteroid effects on proximal femur bone loss. J Bone Miner Res 5:1211–1216PubMedGoogle Scholar
  9. 9.
    Laan RF, van Riel PL, van de Putte LB, van Erning LJ, van Hof MA, Lemmens JA (1993) Low-dose prednisone induces rapid reversible axial bone loss in patients with rheumatoid arthritis: a randomized, controlled study. Ann Int Med 119:963–968PubMedGoogle Scholar
  10. 10.
    Laan RF, van Riel PL, van Erning LJ, Lemmens JA, Ruijs SH, van de Putte LB (1992) Vertebral osteoporosis in rheumatoid arthritis patients: effect of low dose prednisone therapy. Br J Rheumatol 31:91–96PubMedCrossRefGoogle Scholar
  11. 11.
    Buckley LM, Leib ES, Cartularo KS, Vacek PM, Cooper SM (1995) Effects of low dose corticosteroids on the bone mineral density of patients with rheumatoid arthritis. J Rheumatol 22:1155–1159Google Scholar
  12. 12.
    Van Staa TP, Laan RF, Barton IP, Cohen S, Reid DM, Cooper C (2003) Bone density threshold and other predictors of vertebral fracture in patients receiving oral glucocorticoid therapy. Arthritis Rheum 48:3224–3229PubMedCrossRefGoogle Scholar
  13. 13.
    Peel NF, Moore DJ, Barrington NA, Bax DE, Eastell R (1995) Risk of vertebral fracture and relationship to bone mineral density in steroid treated rheumatoid arthritis. Ann Rheum Dis 54:801–806PubMedGoogle Scholar
  14. 14.
    Selby PL, Halsey JP, Adams KRH, Klimiuk P, Knight SM, Pal B, Stewart IM, Swinson DR (2000) Corticosteroids do not alter the threshold for vertebral fracture. J Bone Miner Res 15:952–956PubMedCrossRefGoogle Scholar
  15. 15.
    Wallach S, Cohen S, Reid DM, Highes RA, Hosking DJ, Laan RF, Doherty SM, Maricic M, Rosen C, Brown J, Barton L, Chines AA (2000) Effects of risedronate treatment on bone density and vertebral fracture in patients on corticosteroid therapy. Calcif Tissue Int 67:277–285CrossRefPubMedGoogle Scholar
  16. 16.
    Naganathan V, Jones G, Nash P, Nicholson G, Eisman J, Sambrook PN (2000) Vertebral fracture with long-term corticosteroid therapy: prevalence and relation to age, bone density, and corticosteroid use. Arch Intern Med 160:2917–2922CrossRefPubMedGoogle Scholar
  17. 17.
    Reid IR, Ames R, Evans MC, Sharpe S, Gamble G, France JT, Lim TM, Cundy TF (1992) Determinants of total body and regional bone mineral density in normal postmenopausal women: a key role for fat mass. J Clin Endocrinol Metab 75:45–51CrossRefPubMedGoogle Scholar
  18. 18.
    Bevier WC, Wiswell RA, Pyka G, Kozak KC, Newhall KM, Marcus R (1989) Relationship of body composition, muscle strength, and aerobic capacity to bone mineral density in older men and women. J Bone Miner Res 4:421–432PubMedGoogle Scholar
  19. 19.
    Khosla S, Atkinsen EJ, Riggs BL, Melton LJ III (1996), Relationship between body composition and bone mass in women. J Bone Miner Res 11:857–863PubMedGoogle Scholar
  20. 20.
    Mazess RB, Barden HS, Bisek JP, Hanson J (1990) Dual energy X-ray absorptiometry for total-body and regional bone mineral and soft tissue composition. Am J Clin Nutr 51:1167–1175Google Scholar
  21. 21.
    Chen Q, Kaji H, Iu MF, Nomura R, Sowa H, Yamauchi M, Tsukamoto T, Sugimoto T, Chihara K (2003) Effects of an excess and a deficiency of endogenous parathyroid hormone on volumetric bone mineral density and bone geometry determined by peripheral quantitative computed tomography in female subjects. J Clin Endocrinol Metab 88:2655–2658Google Scholar
  22. 22.
    Nakaoka D, Sugimoto T, Kaji H, Kanzawa M, Yano S, Yamauchi M, Sugishita T, Chihara K (2001) Determinants of bone mineral density and spinal fracture risk in postmenopausal Japanese women. Osteoporos Int 12:548–554CrossRefPubMedGoogle Scholar
  23. 23.
    Smith-Bindman R, Cummings SR, Steiger P, Genant HK (1991) A comparison of morphometric definitions of vertebral fractures. J Bone Miner Res 6:25–34PubMedCrossRefGoogle Scholar
  24. 24.
    Sugimoto T, Nishiyama K, Kuribayashi F, Chihara K (1997) Serum levels of insulin-like growth factor (IGF)-I, IGF-binding protein (IGFBP)-2, and IGFBP-3 in osteoporotic patients with and without spinal fractures. J Bone Miner Res 12:1272–1279PubMedCrossRefGoogle Scholar
  25. 25.
    Gordin JM, Siiteri PK, MacDonald PC (1973) Source of estrogen production in postmenopausal women. J Clin Endocrinol Metab 36:207–214PubMedCrossRefGoogle Scholar
  26. 26.
    Reid IR, Plank LD, Ecans MC (1992) Fat mass is an important determinant of whole body bone density in premenopausal women but not in men. J Clin Endocrinol Metab 75:779–782CrossRefPubMedGoogle Scholar
  27. 27.
    Thomas T, Gori F, Khosla S, Jensen MD, Burguera B, Riggs BL (1999) Leptin acts on human marrow stromal cells to enhance differentiation to osteoblasts and to inhibit differentiation to adipocytes. Endocrinology 140:1630–1638CrossRefPubMedGoogle Scholar
  28. 28.
    Reseland JE, Syversen U, Bakke I, Qvigstad G, Eide LG, Hjertner O, Gordeladze JO, Drevon CA (2001) Leptin is expressed in and secreted from primary cultures of human osteoblasts and promotes bone mineralization. J Bone Miner Res 16:1426–1433PubMedCrossRefGoogle Scholar
  29. 29.
    Yamauchi M, Sugimoto T, Yamaguchi T, Nakaoka D, Kanzawa M, Yano S, Ozuru R, Sugishita T, Chihara K (2001) Plasma leptin concentrations are associated with bone mineral density and the presence of vertebral fractures in postmenopausal women. Clin Endocrinol 55:341–347CrossRefGoogle Scholar
  30. 30.
    Berner HS, Lyngstadaas SP, Spahr A, Monjo M, Thommesen L, Drevon CA, Syversen U, Reseland JE (2004) Adiponectin and its receptors are expressed in bone-forming cells. Bone 35:842–849CrossRefPubMedGoogle Scholar
  31. 31.
    Abad V, Chrousos GP, Reynolds JC, Nieman LK, Hill SC, Weinstein RS, Leong GM (2001) Glucocorticoid excess during adolescence leads to a major persistent deficit in bone mass and an increase in central body fat. J Bone Miner Res 16:1879–1885PubMedCrossRefGoogle Scholar
  32. 32.
    Wajchenberg BL, Bosco A, Marone MM, Levin S, Rocha M, Lerario AC, Nery M, Goldman J, Liberman B (1995) Estimation of body fat and lean tissue distribution by dual energy X-ray absorptiometry and abdominal body fat evaluation by computed tomography in Cushing's disease. J Clin Endocrinol Metab 80:2791–2794CrossRefPubMedGoogle Scholar
  33. 33.
    Kemink SA, Frijns JT, Hermus AR, Pieters GF, Smals AG, van Marken Lichtenbelt WD (1999) Body composition determined by six different methods in women bilaterally adrenalectomized for treatment of Cushing's disease. J Clin Endocrinol Metab 84:3991–3999CrossRefPubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2005

Authors and Affiliations

  • H. Kaji
    • 1
  • T. Tobimatsu
    • 1
  • J. Naito
    • 1
  • M.-F. Iu
    • 1
  • M. Yamauchi
    • 2
  • T. Sugimoto
    • 2
  • K. Chihara
    • 1
  1. 1.Division of Endocrinology/Metabolism, Neurology and Hematology/Oncology, Department of Clinical Molecular MedicineKobe University Graduate School of MedicineChuo-ku, KobeJapan
  2. 2.Division of Endocrinology/Metabolism and Hematological OncologyShimane University School of MedicineIzumo, ShimaneJapan

Personalised recommendations