title: 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.affiliation: Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Inoue
authors.forename: Takayuki
authors.initials: T
authors.lastname: Hamano
authors.forename: Nobuhito
authors.initials: N
authors.lastname: Nango
authors.forename: Isao
authors.initials: I
authors.lastname: Matsui
authors.forename: Kodo
authors.initials: K
authors.lastname: Tomida
authors.forename: Satoshi
authors.initials: S
authors.lastname: Mikami
authors.forename: Naohiko
authors.initials: N
authors.lastname: Fujii
authors.forename: Chikako
authors.initials: C
authors.lastname: Nakano
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Obi
authors.forename: Akihiro
authors.initials: A
authors.lastname: Shimomura
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Kusunoki
authors.forename: Hiromi
authors.initials: H
authors.lastname: Rakugi
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Isaka
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Tsubakihara
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D001842:Bone and Bones / Q000187:drug effects; D002117:Calcitriol / Q000627:therapeutic use; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods; D010024:Osteoporosis / Q000139:chemically induced* / Q000188:drug therapy*; D011446:Prospective Studies; D024482:Vitamin K 2 / Q000031:analogs & derivatives / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D015415:Biomarkers; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D005938:Glucocorticoids; D024482:Vitamin K 2; C030814:menatetrenone; D002117:Calcitriol