Osteoporosis International

, Volume 26, Issue 6, pp 1759–1771 | Cite as

Cortical thinning and progressive cortical porosity in female patients with systemic lupus erythematosus on long-term glucocorticoids: a 2-year case-control study

  • T. Y. Zhu
  • J. F. Griffith
  • L. Qin
  • V. W. Y. Hung
  • T.-N. Fong
  • S.-K. Au
  • X.-L. Tang
  • E. W. Kun
  • A. W. Kwok
  • P.-C. Leung
  • E. K. LI
  • L.-S. TamEmail author
Original Article



In this study, we characterized longitudinal changes of volumetric bone mineral density and cortical and trabecular microstructure at the distal radius using HR-pQCT in female systemic lupus erythematosus (SLE) patients on long-term glucocorticoids. Cortical thinning and increased cortical porosity are the major features of longitudinal microstructural deterioration in SLE patients.


The study aims to characterize longitudinal changes of volumetric bone mineral density (vBMD) and bone microstructure at distal radius in female systemic lupus erythematosus (SLE) patients on long-term glucocorticoids.


This 2-year case-control study consisted of 166 premenopausal subjects (75 SLE patients and 91 controls) and 79 postmenopausal subjects (44 SLE patients and 35 controls). We obtained areal BMD (aBMD) by dual-energy X-ray absorptiometry at multiple skeletal sites and indices of vBMD and microstructure at distal radius by high-resolution peripheral quantitative computed tomography (HR-pQCT) at baseline, 12 and 24 months.


In either premenopausal or postmenopausal subjects, changes in aBMD did not differ between patients and controls except that decrease in aBMD at total hip at 24 months in premenopausal patients was significantly higher. In premenopausal subjects, decrease in cortical area (−0.51 vs. −0.06 %, p = 0.039) and thickness (−0.63 vs. 0.02 %, p = 0.031) and increase in cortical porosity (21.7 vs. 7.16 %, p = 0.030) over study period were significantly larger in patients after adjustment of age and body mass index. Decreased in trabecular vBMD was significantly less (−0.63 vs. −2.32 %, p = 0.001) with trabecular microstructure better maintained in patients. In postmenopausal subjects, decrease in cortical vBMD (−2.66 vs. −1.56 %, p = 0.039) and increase in cortical porosity (41.6 vs. 16.3 %, p = 0.021) were significantly higher in patients, and there was no group-wise difference in change of trabecular microstructure.


Longitudinal microstructural deterioration in SLE is characterized by cortical thinning and increased cortical porosity. Cortical bone is an important source of bone loss in SLE patients on glucocorticoids.


Bone microstructure Glucocorticoids HR-pQCT Osteoporosis Systemic lupus erythematosus 



The work described in this paper was fully supported by a grant from the Research Grant Council of Hong Kong Special Administrative Region, China (CUHK471010). The authors are grateful to Ms. LI Siu Wan for her generous help in the recruitment of study controls.


The work described in this paper was fully supported by a grant from Research Grant Council of the Hong Kong Special Administrative Region, China (project no. CUHK471010).

Ethics approval

This study was conducted with the approval of the Joint Chinese University of Hong Kong—New Territories East Cluster Clinical Research Ethics Committee (Ref. no. CRE-2009.215).

Subject consent


Conflicts of interest



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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2015

Authors and Affiliations

  • T. Y. Zhu
    • 1
    • 2
  • J. F. Griffith
    • 3
  • L. Qin
    • 2
  • V. W. Y. Hung
    • 2
  • T.-N. Fong
    • 2
  • S.-K. Au
    • 4
  • X.-L. Tang
    • 1
  • E. W. Kun
    • 5
  • A. W. Kwok
    • 4
  • P.-C. Leung
    • 4
  • E. K. LI
    • 1
  • L.-S. Tam
    • 1
    • 6
    Email author
  1. 1.Department of Medicine and TherapeuticsThe Chinese University of Hong KongHong Kong SARChina
  2. 2.Bone Quality and Health Center, Department of Orthopedics and TraumatologyThe Chinese University of Hong KongHong Kong SARChina
  3. 3.Department of Imaging and Interventional RadiologyThe Chinese University of Hong KongHong Kong SARChina
  4. 4.The Jockey Club Centre for Osteoporosis Care and ControlThe Chinese University of Hong KongHong Kong SARChina
  5. 5.Department of Medicine and GeriatricsTai Po HospitalHong Kong SARChina
  6. 6.Department of Medicine & TherapeuticsThe Prince of Wales HospitalHong Kong SARChina

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