RESEARCH - High prevalence of vertebral fractures in post-menopausal women receiving chronic steroid therapy

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Bone. 2006 Mar 28; [Epub ahead of print]

High prevalence of asymptomatic vertebral fractures in post-menopausal women

receiving chronic glucocorticoid therapy: A cross-sectional outpatient

study.

Angeli A, Guglielmi G, Dovio A, Capelli G, de Feo D, Giannini S, Giorgino R,

Moro L, Giustina A.

Internal Medicine, University of Turin, Italy.

Glucocorticoid (GC)-induced osteoporosis mostly affects trabecular bone of

vertebrae. Only 30% of vertebral fractures are symptomatic, yet both

clinical and radiological vertebral fractures have been associated with

increased mortality and morbidity. The aims of this cross-sectional,

outpatient-based study were to measure the prevalence of asymptomatic

vertebral fractures in a large sample of post-menopausal women given GCs for

different diseases; to compare prevalence of asymptomatic vertebral

fractures according to disease, GC treatment and major risk factors; and to

assess the quality of life in GC users with and without asymptomatic

vertebral fractures. 551 patients referring to 39 centers as outpatients for

their programmed follow-up and satisfying the inclusion criteria were

included in the analysis. Each patient underwent structured medical

interview (including dose and duration of GC therapy, major risk factors for

osteoporosis, the quality of life questionnaire of the European Foundation

for Osteoporosis (QUALEFFO) and a back function score questionnaire),

thoraco-lumbar radiographs and subsequent morphometry; for 253 and 437

patients, respectively, lumbar spine bone mineral density (BMD) assessed by

dual energy X-ray absorptiometry and calcaneal bone stiffness assessed by

quantitative ultrasonometry were available. The prevalence of asymptomatic

vertebral fractures resulted >37%, with >14% of patients having two or more

asymptomatic vertebral fractures and was much higher than that found in

epidemiological studies on healthy women. Distribution of asymptomatic

vertebral fractures along the spine showed a bimodal pattern, with two peaks

at T7 and T11. The prevalence of asymptomatic vertebral fractures clearly

increased with age. Differences in prevalence among diseases were evidenced.

When controlled for age, GC cumulative dose, duration of therapy and

personal history of fractures, the adjusted prevalences were 30.77% for

systemic lupus erythematosus, 33.78% for rheumatoid arthritis, 37.78% for

asthma/chronic obstructive pulmonary disease, 43.20% for polymyalgia

rheumatica and 43.36% for diseases grouped as " other vasculitides/connective

tissue diseases " . No significant association was found with GC cumulative

dose and duration of therapy. Established risk factors for osteoporosis

(except for age, years since menopause and personal history of fractures),

lumbar spine BMD, calcaneal stiffness and QUALEFFO score were not associated

with number and severity of asymptomatic vertebral fractures. Underlying

disease is likely to contribute to the risk of fracture, but disease by

itself could not be dissected from GC regimen.

Vertebral fractures should be looked for carefully in all post-menopausal

women receiving long-term systemic GCs since they can be asymptomatic and

are scarcely predictable.

PMID: 16574519

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=16574519

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