Efficiency of Quantitative Ultrasound Measurements as Compared with Dual-Energy X-ray Absorptiometry in the Assessment of Corticosteroid-Induced Bone Impairment

Daens, S.; Peretz, Anne; Maertelaer, V De; Moris, Muriel; Bergmann, Pierre

doi:10.1007/s001980050227

Cited by 38 publications

(18 citation statements)

References 25 publications

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“…It is smaller than the 12.7% observed in a cohort of mixed inflammatory disorders using the Lunar Achilles [21]. The difference detected by QUS was greater in magnitude than that detected by calcaneal DXA; furthermore, adjusting calcaneal QUI for calcaneal DXA in a multivariate model did not appreciably reduce the difference between CS users and non-users.…”

Section: Discussioncontrasting

confidence: 66%

Comparison of Calcaneal Ultrasound and DXA to Assess the Risk of Corticosteroid-Induced Osteoporosis: A Cross-sectional Study

et al. 2001

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Patients on long-term oral corticosteroids have an increased risk of low bone mass and fragility fractures. Fracture risk rises soon after commencement of corticosteroid therapy and it is possible that these agents adversely influence bone architecture disproportionately to their effect on bone mass. The best means of assessing bone status in patients using corticosteroids remains uncertain, but quantitative ultrasound of the calcaneus may provide evidence of microarchitectural changes not detected by dual-energy X-ray absorptiometry (DXA). Patients with Crohn's disease have an increased risk of low bone mineral density (BMD), the etiology of which is multifactorial but includes corticosteroid use. We studied 118 consecutive patients with Crohn's disease, 21 of whom used continuous oral corticosteroids, 70 of whom were intermittent users, and 27 who had never used the drug. All patients received DXA of the lumbar spine, hip and calcaneus and quantitative ultrasound (QUS) of the calcaneus. The different techniques were compared using a femoral neck T-score < or = -1.5 as the threshold of corticosteroid-induced osteoporosis. When compared with the femoral neck T-score, there were no significant differences between the predictive values of lumbar spine DXA, calcaneal DXA or calcaneal QUS to identify low femoral neck BMD. However, the absolute T-score required to give similar discriminatory capacity to femoral neck T-score varied substantially (T= -0.81 to -1.5) between the different measurement techniques and sites.

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Section: Discussioncontrasting

confidence: 66%

Comparison of Calcaneal Ultrasound and DXA to Assess the Risk of Corticosteroid-Induced Osteoporosis: A Cross-sectional Study

et al. 2001

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“…Indeed, in this study we found that BUA was reduced by 6.3%, SOS by 1.6% and SI by 15.8% compared with values obtained in control subjects. In the same manner Daens et al [9] showed that QUS measurements were decreased in patients with CIOP (75.8% for BUA, 71.3% for SOS and 712.7% for SI). However, in these two previous studies the decrease in QUS measurements in CIOP was similar to that of BMD LS .…”

Section: Discussionmentioning

confidence: 63%

“…In a recently published study we also showed that QUS parameters were decreased to the same extent as BMD in patients with CIOP due to exogenous glucocorticoid excess [8]. Also Daens et al [9] showed that the Stiffness Index (SI) was decreased by 12.7% (against 11% for BMD at the lumbar spine) in a group of patients receiving pharmacologic doses of steroids for more than 1 year. Nevertheless, to our knowledge QUS parameters of bone have not been assessed in endogenous corticosteroid excess.…”

Section: Introductionmentioning

confidence: 81%

Quantitative Ultrasound of Bone and Markers of Bone Turnover in Cushing's Syndrome

Cortet

Blanckaert

et al. 2001

Osteoporosis International

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Quantitative ultrasound (QUS) of bone is a valuable tool in the assessment of postmenopausal osteoporosis. QUS and new markers of bone turnover have been poorly assessed in Cushing's syndrome, however. Twenty-five patients with Cushing's syndrome (20 women, 3 men; mean age +/- SEM: 38+/-2 years) were studied and compared with 35 age- and sex-matched control patients (mean age +/- SEM: 38+/-2 years). The following variables were measured in both groups: QUS parameters at the heel (BUA; SOS; Stiffness Index, SI); bone mineral density (BMD) at both the lumbar spine (LS) and femoral neck (FN) by dual-energy X-ray absorptiometry; and serum markers of bone turnover (osteocalcin, procollagen type I N- and C-terminal propeptides (PINP and PICP), bone alkaline phosphatase (BAP), procollagen type I C-terminal telopeptide (ICTP) and urinary type I collagen C-telopepetide breakdown products (CTX)). Both BUA and SI were decreased in patients with Cushing's syndrome (p<0.01) but not SOS (p=0.08). BMD was also strongly decreased in Cushing's syndrome, at both the LS and FN (p<0.005). The two markers of bone turnover statistically significantly different between the two groups were osteocalcin (mean + SEM: 3.5 + 0.7 ng/ml (Cushing's syndrome) vs 6.4+/-0.5 ng/ml (controls, p<0.01)) and CTX (mean +/- SEM: 148.7+/-17.1 microg/mmol Cr (Cushing's syndrome) vs 220.8+/-22.9 microg/mmol Cr (controls), p<0.05). The areas under the receiver operating characteristic curve (AUC) were 0.72 (BUA), 0.73 (SI), 0.90 (BMD(LS)), 0.81 (BMD(FN)), 0.83 (osteocalcin) and 0.64 (CTX) respectively. AUC was significantly higher for BMD(LS) than for both BUA and SI (p<0.05). Conversely AUC was not statistically significantly different for BMDFN as compared with either BUA or SI. AUC was also higher for osteocalcin than for other markers of bone turnover. In conclusion, QUS of bone seems to be a relevant tool for assessing bone involvement in Cushing's syndrome. QUS does have a lower sensitivity compared with DXA, however, and the relevance of QUS cannot be ascertained until some longitudinal data are forthcoming. Except for CTX, the other new markers of bone turnover assessed in this study (PINP, PICP, BAP and ICTP) do not seem of interest in Cushing's syndrome.

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“…Quantitative ultrasound evaluations at the heel and hand phalanges have also been investigated as a method of assessing bone loss in GC-treated patients [192,193] . The data are very limited at the present time, and more research is necessary to establish if quantitative ultrasound may be suitable for such a purpose in routine clinical practice.…”

Section: Bmd Assessmentmentioning

confidence: 99%

Glucocorticoid-Induced Osteoporosis: From Basic Mechanisms to Clinical Aspects

Alesci

Martino

Ilias

et al. 2005

Neuroimmunomodulation

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Glucocorticoid (GC)-induced osteoporosis (GCOP) is the most common cause of osteoporosis in adults aged 20–45 years as well as the most common cause of iatrogenic osteoporosis. GC excess, either endogenous or exogenous, induces bone loss in 30–50% of cases. Indeed, bone loss leading to fractures is perhaps the most incapacitating, sometimes partially irreversible, complication of GC therapy. Nevertheless, GCOP is often underdiagnosed and left untreated. The following article provides an update on the cellular and molecular mechanisms implicated in the pathophysiology of GC-induced bone loss, as well as some guidelines on diagnostic, preventive and therapeutic strategies for this medical condition, in an effort to promote a better knowledge and greater awareness of GCOP by both the patient and the physician.

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Efficiency of Quantitative Ultrasound Measurements as Compared with Dual-Energy X-ray Absorptiometry in the Assessment of Corticosteroid-Induced Bone Impairment

Cited by 38 publications

References 25 publications

Comparison of Calcaneal Ultrasound and DXA to Assess the Risk of Corticosteroid-Induced Osteoporosis: A Cross-sectional Study

Comparison of Calcaneal Ultrasound and DXA to Assess the Risk of Corticosteroid-Induced Osteoporosis: A Cross-sectional Study

Quantitative Ultrasound of Bone and Markers of Bone Turnover in Cushing's Syndrome

Glucocorticoid-Induced Osteoporosis: From Basic Mechanisms to Clinical Aspects

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