Osteoporosis International

, Volume 20, Issue 11, pp 1889–1894 | Cite as

Bone fragility in male glucocorticoid-induced osteoporosis is not defined by bone mineral density

  • K. Hayashi
  • M. Yamamoto
  • Y. Murakawa
  • M. Yamauchi
  • H. Kaji
  • T. Yamaguchi
  • T. Sugimoto
Original Article



Eighty-seven male Japanese subjects taking prednisolone ≥5 mg for more than 6 months and 132 age- and body mass index (BMI)-matched control subjects were examined. Multiple regression analysis adjusted for age and BMI showed that spinal bone mineral density (BMD) in the prednisolone group was not associated with prevalent vertebral fractures (VFs).


Glucocorticoid (GC) treatment is known to increase the risk for bone fractures. However, the association between VFs and BMD in GC-treated male patients remains unclear.


Eighty-seven male subjects taking prednisolone ≥5 mg for more than 6 months and 132 age- and BMI-matched control subjects were examined using lateral thoracic and lumbar spine radiographs and spine dual energy X-ray absorptiometry.


The presence of GC use was an independent risk factor for VFs adjusted for age and BMI (odds ratio 10.93, P < 0.001). By receiver operating characteristic analysis, the absolute BMD values for detecting VFs were higher and the sensitivity and specificity were lower in the GC group than in the control group (0.936 vs 0.825 g/cm2 and 53.5% vs 74.0%, respectively). Multiple regression analysis adjusted for age and BMI showed that spinal BMD in the GC group was not associated with prevalent VFs, even after adding current and past maximum GC doses as independent variables.


These results show that lumbar BMD values are not associated with prevalent VFs in GC-treated male patients, suggesting that bone fragility in male GC users is affected by bone quality rather than by BMD.


Bone mineral density Glucocorticoid Men Osteoporosis Vertebral fractures 


  1. 1.
    van Staa TP, Leufkens HG, Cooper C (2002) The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis. Osteoporos Int 13:777–787CrossRefPubMedGoogle Scholar
  2. 2.
    Ross PD (1998) Osteoporosis: epidemiology and risk assessment. J Nutr Health Aging 2:178–183PubMedGoogle Scholar
  3. 3.
    Kaji H, Yamauchi M, Chihara K, Sugimoto T (2006) The threshold of bone mineral density for vertebral fracture in female patients with glucocorticoid-induced osteoporosis. Endocr J 53:27–34CrossRefPubMedGoogle Scholar
  4. 4.
    Tuck SP, Datta HK (2007) Osteoporosis in the aging male: treatment options. Clin Interv Aging 2:521–536PubMedGoogle Scholar
  5. 5.
    Cauley JA (2006) Osteoporosis in men: prevalence and investigation. Clin Cornerstone 8(Suppl 3):S20–25CrossRefPubMedGoogle Scholar
  6. 6.
    Campion JM, Maricic MJ (2003) Osteoporosis in men. Am Fam Phys 67:1521–1526Google Scholar
  7. 7.
    Pande I, Francis RM (2001) Osteoporosis in men. Best Pract Res Clin Rheumatol 15:415–427CrossRefPubMedGoogle Scholar
  8. 8.
    Orimo H, Sugioka Y, Fukunaga M, Mutou Y, Hotokebuchi T, Gorai I, Nakamura T, Kushida K, Tanaka H, Inokai T (1996) Diagnostic criteria for primary osteoporosis in Japan [in Japanese]. Osteoporosis Jpn 4:643–653Google Scholar
  9. 9.
    Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148PubMedCrossRefGoogle Scholar
  10. 10.
    Hanley JA, McNeil BJ (1982) The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143:29–36PubMedGoogle Scholar
  11. 11.
    Kanis JA, Johansson H, Oden A, Johnell O, de Laet C, Melton IL, Tenenhouse A, Reeve J, Silman AJ, Pols HA, Eisman JA, McCloskey EV, Mellstrom D (2004) A meta-analysis of prior corticosteroid use and fracture risk. J Bone Miner Res 19:893–899CrossRefPubMedGoogle Scholar
  12. 12.
    Orwoll ES, Oviatt SK, Mann T (1990) The impact of osteophytic and vascular calcifications on vertebral mineral density measurements in men. J Clin Endocrinol Metab 70:1202–1207CrossRefPubMedGoogle Scholar
  13. 13.
    Liu G, Peacock M, Eilam O, Dorulla G, Braunstein E, Johnston CC (1997) Effect of osteoarthritis in the lumbar spine and hip on bone mineral density and diagnosis of osteoporosis in elderly men and women. Osteoporos Int 7:564–569CrossRefPubMedGoogle Scholar
  14. 14.
    Anonymous (2001) NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy, March 7–29, 2000: highlights of the conference. South Med J 94:569–573Google Scholar
  15. 15.
    Weinstein RS, Jilka RL, Parfitt AM, Manolagas SC (1998) Inhibition of osteoblastogenesis and promotion of apoptosis of osteoblasts and osteocytes by glucocorticoids. Potential mechanisms of their deleterious effects on bone. J Clin Invest 102:274–282CrossRefPubMedGoogle Scholar
  16. 16.
    Dalle Carbonare L, Arlot ME, Chavassieux PM, Roux JP, Portero NR, Meunier PJ (2001) Comparison of trabecular bone microarchitecture and remodeling in glucocorticoid-induced and postmenopausal osteoporosis. J Bone Miner Res 16:97–103CrossRefPubMedGoogle Scholar
  17. 17.
    Akahoshi S, Sakai A, Arita S, Ikeda S, Morishita Y, Tsutsumi H, Ito M, Shiraishi A, Nakamura T (2005) Modulation of bone turnover by alfacalcidol and/or alendronate does not prevent glucocorticoid-induced osteoporosis in growing minipigs. J Bone Miner Metab 23:341–350CrossRefPubMedGoogle Scholar
  18. 18.
    Lane NE, Yao W, Balooch M, Nalla RK, Balooch G, Habelitz S, Kinney JH, Bonewald LF (2006) Glucocorticoid-treated mice have localized changes in trabecular bone material properties and osteocyte lacunar size that are not observed in placebo-treated or estrogen-deficient mice. J Bone Miner Res 21:466–476CrossRefPubMedGoogle Scholar
  19. 19.
    Van Staa TP, Leufkens HG, Abenhaim L, Zhang B, Cooper C (2000) Use of oral corticosteroids and risk of fractures. J Bone Miner Res 15:993–1000CrossRefPubMedGoogle Scholar
  20. 20.
    Compeyrot-Lacassagne S, Tyrrell PN, Atenafu E, Doria AS, Stephens D, Gilday D, Silverman ED (2007) Prevalence and etiology of low bone mineral density in juvenile systemic lupus erythematosus. Arthritis Rheum 56:1966–1973CrossRefPubMedGoogle Scholar
  21. 21.
    Cohen S, Levy RM, Keller M, Boling E, Emkey RD, Greenwald M, Zizic TM, Wallach S, Sewell KL, Lukert BP, Axelrod DW, Chines AA (1999) Risedronate therapy prevents corticosteroid-induced bone loss: a twelve-month, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Arthritis Rheum 42:2309–2318CrossRefPubMedGoogle Scholar
  22. 22.
    Scane AC, Francis RM, Sutcliffe AM, Francis MJ, Rawlings DJ, Chapple CL (1999) Case-control study of the pathogenesis and sequelae of symptomatic vertebral fractures in men. Osteoporos Int 9:91–97CrossRefPubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2009

Authors and Affiliations

  • K. Hayashi
    • 1
  • M. Yamamoto
    • 1
  • Y. Murakawa
    • 2
  • M. Yamauchi
    • 1
  • H. Kaji
    • 3
  • T. Yamaguchi
    • 1
  • T. Sugimoto
    • 1
  1. 1.Internal Medicine 1Shimane University Faculty of MedicineIzumoJapan
  2. 2.Internal Medicine 3Shimane University Faculty of MedicineIzumoJapan
  3. 3.Division of Diabetes, Metabolism, and Endocrinology, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan

Personalised recommendations