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Abnormal microarchitecture and stiffness in postmenopausal women using chronic inhaled glucocorticoids

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Abstract

Summary

Postmenopausal (PM) women using inhaled glucocorticoids (IGCs) had substantial abnormalities in volumetric BMD (vBMD), microarchitecture, and stiffness using high resolution peripheral computed tomography (HRpQCT) compared to age- and race-matched controls. Abnormalities were most severe at the radius. These preliminary results suggest that there may be major, heretofore unrecognized, skeletal deficits in PM women using IGCs.

Introduction

While oral glucocorticoids are well recognized to have destructive skeletal effects, less is known about the effects of IGCs. The detrimental skeletal effects of IGCs may be greatest in PM women, in whom they compound negative effects of estrogen loss and aging. The goal of this study was to evaluate microarchitecture and stiffness in PM women using chronic IGCs.

Methods

This case-control study compared PM women using IGCs for ≥ 6 months (n = 20) and controls matched for age and race/ethnicity (n = 60). Skeletal parameters assessed included areal BMD (aBMD) by DXA, trabecular and cortical vBMD and microarchitecture by HRpQCT of the radius and tibia, and whole bone stiffness by finite element analysis.

Results

By DXA, mean values in both groups were in the osteopenic range; hip aBMD was lower in IGC users (P < 0.04). By HRpQCT, IGC users had lower total, cortical, and trabecular vBMD at both radius and tibia (all P < 0.05). IGC users had lower cortical thickness, lower trabecular number, greater trabecular separation and heterogeneity at the radius (all P < 0.03), and greater heterogeneity at the tibia (P < 0.04). Whole bone stiffness was lower in IGC users at radius (P < 0.03) and tended to be lower at the tibia (P = 0.09).

Conclusions

PM women using IGCs had substantial abnormalities in vBMD, microarchitecture, and stiffness compared to controls. These abnormalities were most severe at the radius. These preliminary results suggest that there may be major, heretofore unrecognized, skeletal deficits in PM women using IGCs.

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Funding source

This work was supported by NIH K23 DK084337 (Stein), NIH U01 AR055968 (Shane), and the Thomas L. Kempner and Katheryn C. Patterson Foundation.

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Authors and Affiliations

  1. Division of Endocrinology and Metabolic Bone Disease, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY, 10021, USA

    Y. Liu & E. M. Stein

  2. Division of Pulmonology, Columbia University College of Physicians and Surgeons, New York, NY, USA

    E. Dimango

  3. Division of Endocrinology, Columbia University College of Physicians and Surgeons, New York, NY, USA

    M. Bucovsky, S. Agarwal, K. Nishiyama & E. Shane

  4. Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA

    X. E. Guo

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  1. Y. Liu
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  2. E. Dimango
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  3. M. Bucovsky
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  7. E. Shane
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  8. E. M. Stein
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Correspondence to E. M. Stein.

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All subjects provided written informed consent and the Institutional Review Board of Columbia University Medical Center approved this study.

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Liu, Y., Dimango, E., Bucovsky, M. et al. Abnormal microarchitecture and stiffness in postmenopausal women using chronic inhaled glucocorticoids. Osteoporos Int 29, 2121–2127 (2018). https://doi.org/10.1007/s00198-018-4591-9

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  • DOI: https://doi.org/10.1007/s00198-018-4591-9

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