Abstract
IntroductionThe purpose of this research is to assess the effects of oral ibandronate on bone microarchitecture by using high-resolution peripheral quantitative computed tomography (HR-pQCT) in patients with systemic lupus erythematosus (SLE) taking a long-term glucocorticoid.MethodsIn this double-blind placebo-controlled study, 40 Chinese female SLE patients taking prednisolone were randomly assigned to receive either monthly oral ibandronate (150 mg) or placebo with daily 1-hydroxycholecalciferol (Alfacalcidol; 1 μg) and calcium supplement for 12 months. Assessments of bone microarchitecture by using HR-pQCT and area bone mineral density (aBMD) of the lumbar spine and hip with dual-energy x-ray absorptiometry (DXA) were performed at baseline and 12 months.ResultsNo differences in baseline characteristics were found between the two groups. After 12 months, no statistical differences were noted in any of the bone densities, microarchitectural parameters, or percentage changes of these parameters, as measured with HR-pQCT or DXA between the two groups. However, within the active group, the percentage improvement was significant in cortical bone density (P = 0.023) which was absent in the placebo group. Improvement was also seen in the aBMD of both the lumbar spine (P < 0.0001) and the hip (P < 0.005). In the placebo group, the percentage increase in trabecular separation was significant (P = 0.04), and the percentage improvement in aBMD in the spine also was significant (P = 0.049).ConclusionsOral ibandronate treatment improves microarchitecture in SLE patients taking long-term glucocorticoid assessed with HR-pQCT, and this new technology may have a role in assessing bony changes in future longitudinal studies in SLE patients.Trial registrationClinicalTrials.gov identifier: NCT00668330.
Highlights
The purpose of this research is to assess the effects of oral ibandronate on bone microarchitecture by using high-resolution peripheral quantitative computed tomography (HR-pQCT) in patients with systemic lupus erythematosus (SLE) taking a long-term glucocorticoid
This suggests two problems: an inherent limitation of measurement of area bone mineral density (aBMD) with dual-energy x-ray absorptiometry (DXA) for clinical assessment of bone-fracture risk, and that glucocorticoids lead to deterioration of bone quality, which cannot be measured with the DXA measurements
By using high-resolution peripheral quantitative computed tomography (HR-pQCT), alterations of bone density and microarchitectures in SLE patients with vertebral fractures when the DXA was unable to show any differences between those with and without vertebral fractures [12]
Summary
The purpose of this research is to assess the effects of oral ibandronate on bone microarchitecture by using high-resolution peripheral quantitative computed tomography (HR-pQCT) in patients with systemic lupus erythematosus (SLE) taking a long-term glucocorticoid. We and others have demonstrated that patients with SLE have a high prevalence of asymptomatic vertebral fractures, even with normal area bone mineral density (aBMD) [9,10,11] This suggests two problems: an inherent limitation of measurement of aBMD with dual-energy x-ray absorptiometry (DXA) for clinical assessment of bone-fracture risk, and that glucocorticoids lead to deterioration of bone quality, which cannot be measured with the DXA measurements. Two cross-sectional studies reported that bone microarchitecture, measured by HR-pQCT at the distal radius, can distinguish postmenopausal women with and without fragility fractures, partly independent of aBMD [13,14] For these reasons, we investigated the effectiveness of using HR-pQCT to determine the effects of a bisphosphonate that has been established in the treatment of glucocorticoid-induced osteoporosis [15,16,17,18,19,20,21,22]. This is the first study using this new technique to assess treatment-related changes in bone architecture in patients with glucocorticoidinduced osteoporosis
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