Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland.
Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.
Front Endocrinol (Lausanne). 2022 Jul 14;13:893600. doi: 10.3389/fendo.2022.893600. eCollection 2022.
Therapy with intravenous glucocorticoids (GCs) is associated with various side effects, however, the impact on bone remains elusive. Trabecular bone score (TBS) is a diagnostic tool providing information on bone microarchitecture based on images obtained from dual-energy X-ray absorptiometry. We investigated the influence of the intravenous methylprednisolone (IVMP) pulse administration on TBS in patients with moderate-to-severe Graves' orbitopathy (GO).
Fifteen patients with GO were treated with 12 IVMP pulses (6x0.5g, 6x0.25 g on a weekly schedule). They received supplementation with 2000 IU of vitamin D and 1.0 g of calcium throughout the study period. TBS was assessed at baseline and after last IVMP pulse. To determine the difference between values at baseline and after treatment the least significant change (LSC) methodology was used. We compared pre- and posttreatment mean TBS values.
We found a significant decrease of TBS in 5 out of 15 (33%) patients. Mean TBS value decreased becoming 2.4% lower than at baseline (p<0.05).
IVMP pulse therapy exerts negative effect on bone microarchitecture in TBS assessment. The analysis of the clinical risk factors for osteoporosis and the evaluation of bone mineral density and TBS should be considered before initiating IVMP therapy.
静脉注射糖皮质激素（GCs）治疗与各种副作用相关，但对骨骼的影响仍不清楚。骨小梁评分（TBS）是一种诊断工具，可根据双能 X 射线吸收法获得的图像提供有关骨微观结构的信息。我们研究了静脉注射甲泼尼龙（IVMP）脉冲给药对中度至重度格雷夫斯眼病（GO）患者 TBS 的影响。
15 名 GO 患者接受了 12 次 IVMP 脉冲治疗（每周 6x0.5g，6x0.25g）。在整个研究期间，他们接受了 2000IU 维生素 D 和 1.0g 钙的补充。在基线和最后一次 IVMP 脉冲后评估 TBS。为了确定治疗前后值之间的差异，使用了最小有意义变化（LSC）方法。我们比较了治疗前后的平均 TBS 值。
我们发现 15 名患者中有 5 名（33%）TBS 显著下降。TBS 值平均下降 2.4%，低于基线（p<0.05）。
IVMP 脉冲治疗对 TBS 评估中的骨微观结构产生负面影响。在开始 IVMP 治疗之前，应考虑分析骨质疏松的临床危险因素以及评估骨矿物质密度和 TBS。
