title: Trabecular bone score in female patients with systemic sclerosis: comparison with rheumatoid arthritis and influence of glucocorticoid exposure.
abstract: OBJECTIVE
  Systemic sclerosis (SSc) is associated with an increased risk of osteoporosis and fractures. To date, the etiology of bone loss in SSc is unclear. Trabecular bone score (TBS) provides an indirect measurement of bone microarchitecture, independent of areal bone mineral density (aBMD). The aims were to assess bone involvement in SSc using TBS in comparison with a "high-risk" population with rheumatoid arthritis (RA) and controls, and to investigate the determinants of a low TBS.
  
  
  METHODS
  This was a cross-sectional study of 65 women with SSc, 138 age-matched female patients with RA, and 227 age-matched female controls. Spine and hip aBMD were assessed using dual-energy X-ray absorptiometry. TBS was calculated from the anteroposterior image of the spine aBMD.
  
  
  RESULTS
  TBS was significantly lower in SSc compared to controls (p < 0.0001) and did not differ from RA (p = 0.128), despite lower cumulative and daily glucocorticoid (GC) dose (p < 0.0001). Further, patients with SSc receiving GC ≥ 5 mg/day had a significantly lower TBS than those receiving GC < 5 mg/day (p = 0.001). Multivariate analysis revealed that a low TBS was independently associated with daily GC dose (OR 5.6, 95% CI 1.7-19.2) and a T score ≤ -2.5 SD (OR 5.0, 95% CI 1.5-7.0) in SSc. No association between GC and TBS was found in RA.
  
  
  CONCLUSIONS
  Our results support the development of a combined approach using both TBS and aBMD for the assessment of bone microarchitecture in inflammatory rheumatic diseases. Our study showed that SSc-related bone involvement is characterized by an impairment in bone quality in addition to reduced bone quantity, and highlights that TBS can identify the negative effect of GC on bone microarchitecture.
authors.affiliation: From the Rheumatology Department A, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris Descartes University; Institut national de la santé et de la recherche médicale (INSERM), Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité, Paris; Med-Imaps-Plateforme Technologique d'Innovation Biomédicale (PTIB)-Hôpital Xavier Arnozan, CHU Bordeaux, Pessac, France.E. Koumakis, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University, and INSERM, Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité; J. Avouac, MD, PhD; E. Toth, MD; J. Payet, MD; A. Kahan, MD, PhD; Y. Allanore, MD, PhD; Catherine Cormier, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University; R. Winzenrieth, PhD, PTIB-Hôpital Xavier Arnozan, CHU Bordeaux.
authors.forename: Eugénie
authors.initials: E
authors.lastname: Koumakis
authors.affiliation: From the Rheumatology Department A, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris Descartes University; Institut national de la santé et de la recherche médicale (INSERM), Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité, Paris; Med-Imaps-Plateforme Technologique d'Innovation Biomédicale (PTIB)-Hôpital Xavier Arnozan, CHU Bordeaux, Pessac, France.E. Koumakis, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University, and INSERM, Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité; J. Avouac, MD, PhD; E. Toth, MD; J. Payet, MD; A. Kahan, MD, PhD; Y. Allanore, MD, PhD; Catherine Cormier, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University; R. Winzenrieth, PhD, PTIB-Hôpital Xavier Arnozan, CHU Bordeaux.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Avouac
authors.affiliation: From the Rheumatology Department A, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris Descartes University; Institut national de la santé et de la recherche médicale (INSERM), Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité, Paris; Med-Imaps-Plateforme Technologique d'Innovation Biomédicale (PTIB)-Hôpital Xavier Arnozan, CHU Bordeaux, Pessac, France.E. Koumakis, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University, and INSERM, Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité; J. Avouac, MD, PhD; E. Toth, MD; J. Payet, MD; A. Kahan, MD, PhD; Y. Allanore, MD, PhD; Catherine Cormier, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University; R. Winzenrieth, PhD, PTIB-Hôpital Xavier Arnozan, CHU Bordeaux.
authors.forename: Renaud
authors.initials: R
authors.lastname: Winzenrieth
authors.affiliation: From the Rheumatology Department A, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris Descartes University; Institut national de la santé et de la recherche médicale (INSERM), Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité, Paris; Med-Imaps-Plateforme Technologique d'Innovation Biomédicale (PTIB)-Hôpital Xavier Arnozan, CHU Bordeaux, Pessac, France.E. Koumakis, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University, and INSERM, Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité; J. Avouac, MD, PhD; E. Toth, MD; J. Payet, MD; A. Kahan, MD, PhD; Y. Allanore, MD, PhD; Catherine Cormier, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University; R. Winzenrieth, PhD, PTIB-Hôpital Xavier Arnozan, CHU Bordeaux.
authors.forename: Emese
authors.initials: E
authors.lastname: Toth
authors.affiliation: From the Rheumatology Department A, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris Descartes University; Institut national de la santé et de la recherche médicale (INSERM), Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité, Paris; Med-Imaps-Plateforme Technologique d'Innovation Biomédicale (PTIB)-Hôpital Xavier Arnozan, CHU Bordeaux, Pessac, France.E. Koumakis, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University, and INSERM, Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité; J. Avouac, MD, PhD; E. Toth, MD; J. Payet, MD; A. Kahan, MD, PhD; Y. Allanore, MD, PhD; Catherine Cormier, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University; R. Winzenrieth, PhD, PTIB-Hôpital Xavier Arnozan, CHU Bordeaux.
authors.forename: Judith
authors.initials: J
authors.lastname: Payet
authors.affiliation: From the Rheumatology Department A, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris Descartes University; Institut national de la santé et de la recherche médicale (INSERM), Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité, Paris; Med-Imaps-Plateforme Technologique d'Innovation Biomédicale (PTIB)-Hôpital Xavier Arnozan, CHU Bordeaux, Pessac, France.E. Koumakis, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University, and INSERM, Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité; J. Avouac, MD, PhD; E. Toth, MD; J. Payet, MD; A. Kahan, MD, PhD; Y. Allanore, MD, PhD; Catherine Cormier, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University; R. Winzenrieth, PhD, PTIB-Hôpital Xavier Arnozan, CHU Bordeaux.
authors.forename: André
authors.initials: A
authors.lastname: Kahan
authors.affiliation: From the Rheumatology Department A, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris Descartes University; Institut national de la santé et de la recherche médicale (INSERM), Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité, Paris; Med-Imaps-Plateforme Technologique d'Innovation Biomédicale (PTIB)-Hôpital Xavier Arnozan, CHU Bordeaux, Pessac, France.E. Koumakis, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University, and INSERM, Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité; J. Avouac, MD, PhD; E. Toth, MD; J. Payet, MD; A. Kahan, MD, PhD; Y. Allanore, MD, PhD; Catherine Cormier, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University; R. Winzenrieth, PhD, PTIB-Hôpital Xavier Arnozan, CHU Bordeaux.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Allanore
authors.affiliation: From the Rheumatology Department A, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris Descartes University; Institut national de la santé et de la recherche médicale (INSERM), Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité, Paris; Med-Imaps-Plateforme Technologique d'Innovation Biomédicale (PTIB)-Hôpital Xavier Arnozan, CHU Bordeaux, Pessac, France.E. Koumakis, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University, and INSERM, Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité; J. Avouac, MD, PhD; E. Toth, MD; J. Payet, MD; A. Kahan, MD, PhD; Y. Allanore, MD, PhD; Catherine Cormier, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University; R. Winzenrieth, PhD, PTIB-Hôpital Xavier Arnozan, CHU Bordeaux. catherine.cormier@cch.aphp.fr.
authors.forename: Catherine
authors.initials: C
authors.lastname: Cormier
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000188:drug therapy; D015519:Bone Density / Q000187:drug effects / Q000502:physiology*; D001842:Bone and Bones / Q000000981:diagnostic imaging* / Q000187:drug effects; D003430:Cross-Sectional Studies; D005260:Female; D005938:Glucocorticoids / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D011859:Radiography; D012595:Scleroderma, Systemic / Q000000981:diagnostic imaging* / Q000188:drug therapy
chemical_list: D005938:Glucocorticoids
keywords: GLUCOCORTICOIDS; OSTEOPOROSIS; SYSTEMIC SCLEROSIS; TRABECULAR BONE SCORE