Multidetector-row computed tomography is useful to evaluate the therapeutic effects of bisphosphonates in glucocorticoid-induced osteoporosis.

Abstract

Osteoporosis is one of the major complications of glucocorticoid therapy. Osteoporosis is usually defined by the levels of bone mineral density (BMD) assessed by dual energy X-ray absorptiometry (DEXA); however, glucocorticoids often induce fractures in patients with normal BMD. Thus, novel diagnostic approaches are required. In this study, we examined whether multidetector-row computed tomography (MDCT) is useful to assess the bone status in glucocorticoid-induced osteoporosis (GIO). Because bisphosphonates have been proven to prevent bone fracture in GIO, we tried to detect the therapeutic effects of bisphosphonates in GIO by MDCT. Fifteen Japanese patients with immunoglobulin A nephropathy who had normal renal function were enrolled in this open-label randomized trial. Patients were randomly divided into three groups-calcitriol (VD), menatetrenone (VK), or bisphosphonate (Bis). Bone conditions were analyzed twice by three different methods-bone turnover markers, DEXA, and MDCT-at the start and 6 months after the start of therapy. Both bone markers and DEXA could not detect significant differences among the therapeutic groups; however, MDCT-based analyses detected the preventive effects of bisphosphonates in GIO. Compared to VD, Bis improved structural indices, such as bone volume fraction, trabecular separation, marrow star volume, and structure model index whereas the difference between VD and VK was not significant. Finite element analysis revealed that simulated fracture load in the Bis group was significantly improved. These findings suggested that MDCT-based assessment is superior to bone markers and/or DEXA in assessing the therapeutic effect of bisphosphonates on GIO.

• Authors: Kazunori Inoue, Takayuki Hamano, Nobuhito Nango, Isao Matsui, Kodo Tomida, Satoshi Mikami, Naohiko Fujii, Chikako Nakano, Yoshitsugu Obi, Akihiro Shimomura, Yasuo Kusunoki, Hiromi Rakugi, Yoshitaka Isaka, Yoshiharu Tsubakihara
• Journal: Journal of bone and mineral metabolism (J Bone Miner Metab) Vol. 32 Issue 3 Pg. 271-80 (May 2014) ISSN: 1435-5604 [Electronic] Japan
• PMID: 23832575 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers
• Bone Density Conservation Agents
• Diphosphonates
• Glucocorticoids
• Vitamin K 2
• menatetrenone
• Calcitriol

Topics

• Adolescent
• Adult
• Biomarkers (metabolism)
• Bone Density (drug effects)
• Bone Density Conservation Agents (therapeutic use)
• Bone and Bones (drug effects)
• Calcitriol (therapeutic use)
• Diphosphonates (therapeutic use)
• Female
• Glucocorticoids (administration & dosage, adverse effects)
• Humans
• Male
• Middle Aged
• Multidetector Computed Tomography (methods)
• Osteoporosis (chemically induced, drug therapy)
• Prospective Studies
• Vitamin K 2 (analogs & derivatives, therapeutic use)
• Young Adult