绝经后女性长期吸入糖皮质激素导致的微观结构异常和硬度增加。
Abnormal microarchitecture and stiffness in postmenopausal women using chronic inhaled glucocorticoids.
机构信息
Division of Endocrinology and Metabolic Bone Disease, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY, 10021, USA.
Division of Pulmonology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
出版信息
Osteoporos Int. 2018 Sep;29(9):2121-2127. doi: 10.1007/s00198-018-4591-9. Epub 2018 Jun 11.
UNLABELLED
Postmenopausal (PM) women using inhaled glucocorticoids (IGCs) had substantial abnormalities in volumetric BMD (vBMD), microarchitecture, and stiffness using high resolution peripheral computed tomography (HRpQCT) compared to age- and race-matched controls. Abnormalities were most severe at the radius. These preliminary results suggest that there may be major, heretofore unrecognized, skeletal deficits in PM women using IGCs.
INTRODUCTION
While oral glucocorticoids are well recognized to have destructive skeletal effects, less is known about the effects of IGCs. The detrimental skeletal effects of IGCs may be greatest in PM women, in whom they compound negative effects of estrogen loss and aging. The goal of this study was to evaluate microarchitecture and stiffness in PM women using chronic IGCs.
METHODS
This case-control study compared PM women using IGCs for ≥ 6 months (n = 20) and controls matched for age and race/ethnicity (n = 60). Skeletal parameters assessed included areal BMD (aBMD) by DXA, trabecular and cortical vBMD and microarchitecture by HRpQCT of the radius and tibia, and whole bone stiffness by finite element analysis.
RESULTS
By DXA, mean values in both groups were in the osteopenic range; hip aBMD was lower in IGC users (P < 0.04). By HRpQCT, IGC users had lower total, cortical, and trabecular vBMD at both radius and tibia (all P < 0.05). IGC users had lower cortical thickness, lower trabecular number, greater trabecular separation and heterogeneity at the radius (all P < 0.03), and greater heterogeneity at the tibia (P < 0.04). Whole bone stiffness was lower in IGC users at radius (P < 0.03) and tended to be lower at the tibia (P = 0.09).
CONCLUSIONS
PM women using IGCs had substantial abnormalities in vBMD, microarchitecture, and stiffness compared to controls. These abnormalities were most severe at the radius. These preliminary results suggest that there may be major, heretofore unrecognized, skeletal deficits in PM women using IGCs.
未注明
与年龄和种族匹配的对照组相比，使用吸入性糖皮质激素（IGC）的绝经后（PM）女性的体积骨密度（vBMD）、微结构和硬度存在明显异常。在桡骨处异常最为严重。这些初步结果表明，使用 IGC 的 PM 女性可能存在严重的、以前未被认识到的骨骼缺陷。
引言
虽然口服糖皮质激素对骨骼有明显的破坏性影响，但对 IGC 的影响知之甚少。IGC 对骨骼的有害影响在 PM 女性中可能最大，因为她们使雌激素丧失和衰老的负面影响更加严重。本研究的目的是评估使用慢性 IGC 的 PM 女性的微结构和硬度。
方法
这项病例对照研究比较了使用 IGC 治疗≥6 个月的 PM 女性（n=20）和年龄和种族/民族匹配的对照组（n=60）。评估的骨骼参数包括 DXA 的面积骨密度（aBMD）、桡骨和胫骨的小梁和皮质 vBMD 和微结构以及有限元分析的整体骨骼刚度。
结果
根据 DXA，两组的平均值均处于骨质疏松范围；IGC 使用者的髋部 aBMD 较低（P<0.04）。根据 HRpQCT，IGC 使用者的桡骨和胫骨的总、皮质和小梁 vBMD 均较低（均 P<0.05）。IGC 使用者的皮质厚度较低、小梁数量较少、小梁分离和桡骨异质性较大（均 P<0.03），胫骨异质性较大（P<0.04）。桡骨的整体骨骼刚度在 IGC 使用者中较低（P<0.03），在胫骨处也有下降趋势（P=0.09）。
结论
与对照组相比，使用 IGC 的 PM 女性的 vBMD、微结构和硬度存在明显异常。在桡骨处异常最为严重。这些初步结果表明，使用 IGC 的 PM 女性可能存在严重的、以前未被认识到的骨骼缺陷。
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