Abnormal microarchitecture and stiffness in postmenopausal women using chronic inhaled glucocorticoids.
Abnormal microarchitecture and stiffness in postmenopausal women using chronic inhaled glucocorticoids.
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DOI：
10.1007/s00198-018-4591-9
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发表时间：
2018-09
期刊：
影响因子：
--
通讯作者：
Stein EM
中科院分区：
文献类型：
--
作者：
Liu Y;Dimango E;Bucovsky M;Agarwal S;Nishiyama K;Guo XE;Shane E;Stein EM
众所周知，口服糖皮质激素对骨骼具有破坏性作用，但吸入糖皮质激素（IGCs）的作用却鲜为人知。IGCs对骨骼的有害影响可能在绝经后（PM）妇女中最大，在这些妇女中，它们复合了雌激素丧失和衰老的负面影响。本研究的目的是评估慢性IGCs患者的微结构和僵硬度。本病例对照研究比较了使用IGCs≥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测量的面积骨密度（aBMD）、小梁和皮质体积骨密度（vBMD）、桡骨和胫骨高分辨率周围计算机断层扫描（HRpQCT）的微结构以及有限元分析的全骨刚度。通过DXA，两组的平均值均在骨质减少范围内；IGC使用者的髋关节aBMD较低（P<0.04）。通过HRpQCT， IGC使用者在桡骨和胫骨的总、皮质和小梁vBMD均较低（均P<0.05）。IGC使用者皮质厚度较低，小梁数量较少，桡骨小梁分离程度和异质性较大（P<0.03），胫骨骨小梁异质性较大（P< 0.04）。IGC使用者的全骨刚度在桡骨处较低（P<0.03），在胫骨处趋于较低（P=0.09）。与对照组相比，使用IGCs的PM女性在vBMD、微结构和刚度方面存在实质性异常。这些异常在桡骨处最为严重。这些初步结果表明，在使用IGCs的PM女性中可能存在迄今未被认识到的主要骨骼缺陷。
While oral glucocorticoids are well recognized to have destructive skeletal effects, less is known about the effects of inhaled glucocorticoids (IGCs). The detrimental skeletal effects of IGCs may be greatest in postmenopausal (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. 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 volumetric BMD (vBMD) and microarchitecture by high resolution peripheral computed tomography (HRpQCT) of the radius and tibia and whole bone stiffness by finite element analysis. 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). 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.
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