Shen J, et al. - Authors assessed whether volumetric bone mineral density (vBMD), microarchitecture, and estimated bone strength derived from high-resolution peripheral quantitative computed tomography can discriminate vertebral fractures in patients with glucocorticoid-induced osteoporosis (GIOP) independent of areal bone mineral density (aBMD). A significant reduction in total vBMD and cortical thinning independent of aBMD and fracture risk assessment tool (FRAX) was observed in the patients with GIOP and vertebral fracture. Findings indicate that these changes may help to identify high-risk patients in the subgroups currently considered to have low fracture risk as assessed by dual-energy x-ray absorptiometry (DXA) or FRAX.

Methods

• Experts conducted a cross-sectional case-control study in seven regional hospitals in Hong Kong.
• A total of 110 patients on long-term glucocorticoids with vertebral fracture, determined radiographically, and 110 patients on long-term glucocorticoids without fracture were included in the study.
• The main outcome measures included vBMD, microarchitecture, and bone strength; aBMD; and FRAX.

Results

• Findings suggested that the patients with vertebral fracture had lower total vBMD and a thinner cortex at the distal tibia after adjustment for age, sex, and aBMD or FRAX.
• In the antiresorptive treatment–naive subgroup, lower total vBMD at both the distal radius and the tibia after adjustment for covariates was also observed in patients with vertebral fracture.
• Lower total vBMD and a thinner cortex in the nonosteoporotic or FRAX score of <10% subgroups with vertebral fracture were also reported and correlated to increasing prevalence of vertebral fracture.