Abstract
Chronic glucocorticoid therapy is associated with osteoporosis and can cause
fractures in up to 50% of patients. Increased risk of fractures in
patients with glucocorticoid-induced osteoporosis does not result only from the
decreased bone mineral density (BMD) but also bone microarchitecture
deterioration. Trabecular bone score (TBS) is a method complementary to DXA,
providing additional information about trabecular bone structure. The aim of
this study was to assess the clinical utility of TBS in fracture risk assessment
of patients treated with glucocorticoids. Patients with rheumatic diseases
treated with glucocorticoids for at least 3 months were enrolled. All recruited
patients underwent DXA with additional TBS assessment. We analyzed the frequency
of osteoporosis and osteoporotic fractures and assessed factors that might be
associated with the risk of osteoporotic fractures. A total of 64 patients were
enrolled. TBS and TBS T-score values were significantly lower in patients with
osteoporosis compared to patients without osteoporosis. Low energy fractures
occurred in 19 patients. The disturbed bone microarchitecture was found in
30% of patients with fractures without osteoporosis diagnosis based on
BMD. In the multivariate analysis, only TBS and age were significantly
associated with the occurrence of osteoporotic fractures. TBS reflects the
influence of glucocorticoid therapy on bone quality better than DXA measured BMD
and provides an added value to DXA in identifying the group of patients
particularly prone to fractures.
Key words
osteoporosis - glucocorticoids - fractures - trabecular bone score
