与对照组相比，3特斯拉磁共振成像（MRI）检测发现长期使用糖皮质激素的患者股骨近端微结构和强度出现恶化。
3 Tesla MRI detects deterioration in proximal femur microarchitecture and strength in long-term glucocorticoid users compared with controls.
作者信息
Chang Gregory, Rajapakse Chamith S, Regatte Ravinder R, Babb James, Saxena Amit, Belmont H Michael, Honig Stephen
机构信息
Department of Radiology, Center for Biomedical Imaging, NYU Langone Medical Center, New York, New York, USA.
Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
出版信息
J Magn Reson Imaging. 2015 Dec;42(6):1489-96. doi: 10.1002/jmri.24927. Epub 2015 Jun 12.
BACKGROUND
Glucocorticoid-induced osteoporosis (GIO) is the most common secondary form of osteoporosis, and glucocorticoid users are at increased risk for fracture compared with nonusers. There is no established relationship between bone mineral density (BMD) and fracture risk in GIO. We used 3 Tesla (T) MRI to investigate how proximal femur microarchitecture is altered in subjects with GIO.
METHODS
This study had institutional review board approval. We recruited 6 subjects with long-term (> 1 year) glucocorticoid use (median age = 52.5 (39.2-58.7) years) and 6 controls (median age = 65.5 [62-75.5] years). For the nondominant hip, all subjects underwent dual-energy x-ray absorptiometry (DXA) to assess BMD and 3T magnetic resonance imaging (MRI, 3D FLASH) to assess metrics of bone microarchitecture and strength.
RESULTS
Compared with controls, glucocorticoid users demonstrated lower femoral neck trabecular number (-50.3%, 1.12 [0.84-1.54] mm(-1) versus 2.27 [1.88-2.73] mm(-1) , P = 0.02), plate-to-rod ratio (-20.1%, 1.48 [1.39-1.71] versus 1.86 [1.76-2.20], P = 0.03), and elastic modulus (-64.8% to -74.8%, 1.54 [1.22-3.19] GPa to 2.31 [1.87-4.44] GPa versus 6.15 [5.00-7.09] GPa to 6.59 [5.58-7.31] GPa, P < 0.05), and higher femoral neck trabecular separation (+192%, 0.705 [0.462-1.00] mm versus 0.241 [0.194-0.327] mm, P = 0.02). There were no differences in femoral neck trabecular thickness (-2.7%, 0.193 [0.184-0.217] mm versus 0.199 [0.179-0.210] mm, P = 0.94) or femoral neck BMD T-scores (+20.7%, -2.1 [-2.8 to -1.4] versus -2.6 [-3.3 to -2.5], P = 0.24) between groups.
CONCLUSION
The 3T MRI can potentially detect detrimental changes in proximal femur microarchitecture and strength in long-term glucocorticoid users.
背景
糖皮质激素诱导的骨质疏松症（GIO）是最常见的继发性骨质疏松症形式，与未使用糖皮质激素者相比，使用糖皮质激素者骨折风险增加。在GIO中，骨矿物质密度（BMD）与骨折风险之间尚无明确关系。我们使用3特斯拉（T）磁共振成像（MRI）来研究GIO患者近端股骨的微观结构是如何改变的。
方法
本研究获得了机构审查委员会的批准。我们招募了6名长期（>1年）使用糖皮质激素的受试者（中位年龄=52.5[39.2 - 58.7]岁）和6名对照者（中位年龄=65.5[62 - 75.5]岁）。对于非优势髋，所有受试者均接受双能X线吸收测定法（DXA）以评估BMD，并接受3T磁共振成像（MRI，3D FLASH）以评估骨微观结构和强度指标。
结果
与对照者相比，使用糖皮质激素者的股骨颈小梁数量更低（-50.3%，1.12[0.84 - 1.54]mm⁻¹对2.27[1.88 - 2.73]mm⁻¹，P = 0.02）、板杆比更低（-20.1%，1.48[1.39 - 1.71]对1.86[1.76 - 2.20]，P = 0.03）以及弹性模量更低（-64.8%至-74.8%，1.54[1.22 - 3.19]GPa至2.31[1.87 - 4.44]GPa对6.15[5.00 - 7.09]GPa至6.59[5.58 - 7.31]GPa，P < 0.05），而股骨颈小梁间距更高（+192%，0.705[0.462 - 1.00]mm对0.241[0.194 - 0.327]mm，P = 0.02）。两组之间股骨颈小梁厚度（-2.7%，0.193[0.184 - 0.217]mm对0.199[0.179 - 0.210]mm，P = 0.94）或股骨颈BMD T值（+20.7%，-2.1[-2.8至-1.4]对-2.6[-3.3至-2.5]，P = 0.24）无差异。
结论
3T MRI有可能检测出长期使用糖皮质激素者近端股骨微观结构和强度的有害变化。
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