So Ho, Griffith James Francis, Lau Sze-Lok, Hung Vivian Wing Yin, Lee Violet Ka Lai, Kwok Kitty Yan, Ying Shirley King Yee, Lee Jack Jock Wai, Chan Crystal Ying, Qin Ling, Tam Lai-Shan
Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
Department of Imaging & Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China.
J Orthop Translat. 2025 Jan 22;51:329-336. doi: 10.1016/j.jot.2024.11.001. eCollection 2025 Mar.
Fracture risk in patients on long-term glucocorticoid (LTGC) is only partially explained by impaired areal bone mineral density (aBMD). HR-pQCT derived bone microstructure and bone strength indices could improve fracture prediction beyond aBMD or FRAX in the general population. Abnormalities in these indices could discriminate rheumatic disease patients on LTGC with and without fragility fracture in cross-sectional studies.
To ascertain whether compromised bone quality and strength at baseline could predict incident fragility fracture (IFF) in rheumatic disease patients on LTGC.
Setting and Participants: Multi-centre, longitudinal study of patients with rheumatic diseases on LTGC.
Spine radiographs, aBMD and HR-pQCT were done at baseline and repeated after a period of 5 years. The occurrence of IFF was documented.
A total of 140 patients completed the study, 47 (33.6 %) of whom developed new fractures. After adjusting for age, patients with IFF had significantly worse baseline trabecular volumetric BMD (vBMD), trabecular bone volume fraction, and estimated bone strength at the tibia (RRs 1.51-1.58). Associations remained significant in multivariate models including total hip aBMD, but were insignificant in regressions including previous fractures or FRAX. There were no differences in change in HR-pQCT parameters after 5 years between groups with or without IFF. The area under curve (AUC) generated from a model comprising age, previous fracture history, and tibial trabecular vBMD at baseline (0.710) was comparable with those of FRAX score (0.679/0.702).
Impairment of bone microarchitecture and strength in the trabecular compartment of the tibia could help predict the occurrence of IFF in rheumatic disease patients on LTGC.
These results demonstrate the potential of developing a HR-pQCT-IFF prediction model specifically for rheumatic disease patients on LTGC.
长期使用糖皮质激素（LTGC）的患者骨折风险仅部分可由骨面积骨密度（aBMD）受损来解释。在普通人群中，高分辨率外周定量计算机断层扫描（HR-pQCT）得出的骨微结构和骨强度指标可以在aBMD或骨折风险评估工具（FRAX）之外改善骨折预测。在横断面研究中，这些指标的异常可以区分长期使用糖皮质激素的风湿性疾病患者有无脆性骨折。
确定基线时受损的骨质量和强度是否可以预测长期使用糖皮质激素的风湿性疾病患者发生脆性骨折（IFF）。
设置与参与者：对长期使用糖皮质激素的风湿性疾病患者进行多中心纵向研究。
在基线时进行脊柱X线摄影、aBMD和HR-pQCT检查，并在5年后重复检查。记录IFF的发生情况。
共有140名患者完成了研究，其中47名（33.6%）发生了新骨折。在调整年龄后，发生IFF的患者基线时小梁骨体积密度（vBMD）、小梁骨体积分数和胫骨估计骨强度明显更差（相对风险为1.51 - 1.58）。在包括全髋aBMD的多变量模型中，相关性仍然显著，但在包括既往骨折或FRAX的回归分析中不显著。发生或未发生IFF的组在5年后HR-pQCT参数变化方面没有差异。由包括年龄、既往骨折史和基线时胫骨小梁vBMD的模型生成的曲线下面积（AUC）（0.710）与FRAX评分的曲线下面积（0.679/0.702）相当。
胫骨小梁区骨微结构和强度受损有助于预测长期使用糖皮质激素治疗的风湿性疾病患者发生IFF。
这些结果证明了开发专门针对长期使用糖皮质激素的风湿性疾病患者的HR-pQCT - IFF预测模型的潜力。
