Cortical thinning and progressive cortical porosity in female patients with systemic lupus erythematosus on long-term glucocorticoids: a 2-year case-control study

Zhu, Tracy Y.; Griffith, James F.; Qin, Ling; Hung, Vivian Wing‐Yin; Fong, T.-N.; Au, Shannon Wing Ngor; Tang, Xiao; Kun, Emily W.; Kwok, Anthony; Leung, Ping Chung; Li, E. K.; Tam, Lai‐Shan

doi:10.1007/s00198-015-3077-2

Cited by 29 publications

(17 citation statements)

References 42 publications

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“…HR‐pQCT was also used to characterize changes in bone architecture in women with systemic lupus erythematosus treated long‐term with glucocorticoids. Cortical thinning and increased cortical porosity were the features of longitudinal microstructural deterioration in treated individuals …”

Section: Bone Quality Changes In Diseasementioning

confidence: 99%

“…Cortical thinning and increased cortical porosity were the features of longitudinal microstructural deterioration in treated individuals. 62 In addition to lupus and rheumatoid arthritis, asthma, and other conditions in which glucocorticoids are used for extended periods, fracture risk is increased in individuals with COPD taking inhaled steroids. While life-style features leading to COPD also affect bone turnover and fracture risk, 63 there is a single study 64 comparing bone quality in newly formed and older bone of individuals with COPD who did and did not sustain fragility fractures on the basis of Raman spectroscopy.…”

Section: Secondary Osteoporosismentioning

confidence: 99%

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Bone quality changes associated with aging and disease: a review

Boskey

Imbert

2017

Annals of the New York Academy of Sciences

119

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Bone quality encompasses all the characteristics of bone that, in addition to density, contribute to its resistance to fracture. In this review, we consider changes in architecture, porosity and composition, including collagen structure, mineral composition and crystal size. These factors all are known to vary with tissue and animal ages, and health status. Bone morphology and presence of micro-cracks which also contribute to bone quality, will not be discussed in this review. Correlations with mechanical performance for collagen cross-linking, crystallinity and carbonate content are contrasted with mineral content. Age dependent changes in humans and rodents are discussed in terms of using rodent models of disease. Examples are osteoporosis, osteomalacia, osteogenesis imperfecta, and osteopetrosis, in both humans and animal models. Each of these conditions, along with aging, are associated with increased fracture risk for distinct reasons.

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Section: Bone Quality Changes In Diseasementioning

confidence: 99%

Section: Secondary Osteoporosismentioning

confidence: 99%

Bone quality changes associated with aging and disease: a review

Boskey

Imbert

2017

Annals of the New York Academy of Sciences

119

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“…Interestingly, also in SLE patients, it is the cortical bone that is predominantly affected. 21 However, there are also studies showing a trabecular bone loss in SLE patients, 23 but these effects are not as prominent as the cortical effects and it remains unclear how much of the trabecular phenotype is due to the glucocorticoid treatment in these patients.…”

Section: Discussionmentioning

confidence: 99%

Osteoporosis in a murine model of postmenopausal lupus

Nordqvist

Lagerquist

Grahnemo

et al. 2019

Lupus

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Background/objective Postmenopausal women with systemic lupus erythematosus have an increased risk of osteoporosis and associated fractures. Their increased osteoporosis risk is probably caused by a high level of inflammation, use of glucocorticoids, impaired kidney function, and early menopause as these are known risk factors for osteoporosis. Due to these risk factors and the lack of safe and effective treatments, new therapies for the treatment of osteoporosis in this group of patients are needed. Ovariectomized MRL/ lpr mice constitute a well-established model for studies of postmenopausal systemic lupus erythematosus; however, it is not clear to what extent this experimental model is associated with the development of osteoporosis. Thus, the aim of this study was to characterize the skeleton of ovariectomized MRL/ lpr mice to determine the suitability of this model in studies of prospective new therapies for osteoporosis in postmenopausal systemic lupus erythematosus patients. Methods Skeletal parameters were measured in MRL/ lpr mice and MRL/++ control mice, using peripheral quantitative computed tomography, high-resolution micro-computed tomography and biomechanical analyses. mRNA expression of bone-remodeling markers was measured by quantitative polymerase chain reaction and serological markers of lupus disease were evaluated using ELISA. Results Total bone mineral density was reduced in MRL/ lpr mice compared with MRL/++ mice and MRL/ lpr mice had reduced cortical and trabecular bone thickness compared with MRL/++ mice. In line with the low bone mass of MRL/ lpr mice, gene expression analysis of cortical bone from these mice indicated an increased osteoclast activity as well as a decreased osteoblastogenesis and osteoblast activity, compared with MRL/++ mice. Conclusion Ovariectomized MRL/ lpr mice constitute a valuable experimental model for studies of osteoporosis development in postmenopausal systemic lupus erythematosus and this model is thus suitable for future studies of osteoporosis treatment in systemic lupus erythematosus.

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“…High-resolution peripheral quantitative computed tomography (HR-pQCT) is an emerging method for the assessment of bone microarchitecture, geometry and bone strength. A limited number of studies using HR-pQCT as imaging modality in SLE were published and demonstrated reduced bone strength in patients with SLE (both in patients on long-term GC therapy and in patients not using GCs) compared to healthy controls [ 64 , 65 ]. HR-pQCT might be a better modality for the prediction of fracture risk in patients with SLE than DXA.…”

Section: Relationship Between Bone Mineral Density and Fractures In Smentioning

confidence: 99%

Bone Disease in Connective Tissue Disease/Systemic Lupus Erythematosus

Bultink

2017

Calcif Tissue Int

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This article reviews recent advances in the research of the mechanisms of bone loss, as well as clinical features, economic impact and therapeutic implications of osteoporosis and fractures in patients with systemic lupus erythematosus (SLE) as an illustration of bone disease in a complex systemic autoimmune connective tissue disease. Recent studies demonstrated an increased incidence of osteoporosis and peripheral and vertebral fractures in patients with SLE. The aetiology of bone loss in SLE is multifactorial, including clinical osteoporosis risk factors, systemic inflammation, serological factors, metabolic factors, hormonal factors, possibly genetic factors and medication-induced adverse effects. The incidence of symptomatic fractures in patients with SLE is increased 1.2–4.7-fold and age, disease duration, glucocorticoid use, previous cyclophosphamide use, seizures and a prior cerebrovascular event have been identified as important risk factors. Moreover, a high prevalence of morphometric vertebral fractures was demonstrated, while one in three of these patients has normal bone density, which finding points to the multifactorial aetiology of fractures in SLE. The clinical consequences and economic burden of osteoporosis and fractures as glucocorticoid treatment-related adverse events and the high frequency of glucocorticoid therapy underline the importance of reducing glucocorticoid treatment and prescribing steroid-sparing agents. No data on fall risk and its determinants and the relationship with the occurrence of fractures in patients with SLE are currently available. Fall risk might be increased in lupus patients for several reasons. In addition, the recently reported high prevalence (20%) of frailty in SLE patients may contribute to the increased fracture incidence. Therefore, the relationships between fall risk, frailty and fracture occurrence in SLE might be interesting subjects for future studies.

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Cortical thinning and progressive cortical porosity in female patients with systemic lupus erythematosus on long-term glucocorticoids: a 2-year case-control study

Abstract: Longitudinal microstructural deterioration in SLE is characterized by cortical thinning and increased cortical porosity. Cortical bone is an important source of bone loss in SLE patients on glucocorticoids.

Cited by 29 publications

References 42 publications

Bone quality changes associated with aging and disease: a review

Bone quality changes associated with aging and disease: a review

Osteoporosis in a murine model of postmenopausal lupus

Bone Disease in Connective Tissue Disease/Systemic Lupus Erythematosus

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