Notable difference between the development of vertebral fracture and osteonecrosis of the femoral head in patients treated with high-dose glucocorticoids for systemic rheumatic diseases

Hideto Kameda, Koichi Amano, Hayato Nagasawa, Hiroe Ogawa, Naoya Sekiguchi, Hirofumi Takei, Katsuya Suzuki, Tsutomu Takeuchi

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objective: Vertebral fracture (VF) and osteonecrosis of the femoral head (OFH) are serious concerns in patients with rheumatic diseases treated with high-dose glucocorticoids (GCs). We comparatively examined the risk factors of VF and OFH in patients who had recently received high-dose GC therapy. Patients and Methods: Patients with rheumatic diseases receiving GCs (≥0.5 mg/kg/day for prednisolone equivalent) within the past 2 months were enrolled in this study, and treated with 200 mg/day of etidronate cyclically. The bone mineral density (BMD) of the lumbar spine (L2-4) was examined by QDR2000. OFH was evaluated by magnetic resonance imaging (MRI). [ClinicalTrials.gov identifier: NCT00679978]. Results: Forty-four patients completed the 2-year study including annual X-rays and the BMD analysis. MRI evaluation at entry and 2 years was performed in 41 patients. The BMD values with anteroposterior (AP) and lateral views decreased by 6.4% and 9.7%, respectively, in the first year, but were stable in the second year. Eleven patients developed VF and 9 patients developed OFH. The risk factors for VF included previous VF and a low BMD value (T score<-1.5) of AP view at baseline with an odds ratio (OR) of 14.9 (95% CI 2.9-76.4), while the risk factor for OFH was a recent maximum GC dosage (>1.2 mg/kg/day versus≤; OR=7.7, 95%CI 1.3-45.5) and a decrease in BMD value of lateral view (>15% versus≤ OR=6.7, 95% CI 1.2-36.1) in the first year. Conclusion: The development of VF relies on the predisposing factors, while that of OFH depends on the response to high-dose GC therapy.

Original languageEnglish
Pages (from-to)1931-1938
Number of pages8
JournalInternal Medicine
Volume48
Issue number22
DOIs
Publication statusPublished - 2009
Externally publishedYes

Fingerprint

Femoral Fractures
Osteonecrosis
Rheumatic Diseases
Glucocorticoids
Bone Density
Thigh
Magnetic Resonance Imaging
Etidronic Acid
Prednisolone
Causality
Spine
X-Rays
Therapeutics

Keywords

  • Aseptic necrosis
  • Corticosteroids
  • Osteoporosis
  • Systemic lupus erythematosus

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Notable difference between the development of vertebral fracture and osteonecrosis of the femoral head in patients treated with high-dose glucocorticoids for systemic rheumatic diseases. / Kameda, Hideto; Amano, Koichi; Nagasawa, Hayato; Ogawa, Hiroe; Sekiguchi, Naoya; Takei, Hirofumi; Suzuki, Katsuya; Takeuchi, Tsutomu.

In: Internal Medicine, Vol. 48, No. 22, 2009, p. 1931-1938.

Research output: Contribution to journalArticle

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title = "Notable difference between the development of vertebral fracture and osteonecrosis of the femoral head in patients treated with high-dose glucocorticoids for systemic rheumatic diseases",
abstract = "Objective: Vertebral fracture (VF) and osteonecrosis of the femoral head (OFH) are serious concerns in patients with rheumatic diseases treated with high-dose glucocorticoids (GCs). We comparatively examined the risk factors of VF and OFH in patients who had recently received high-dose GC therapy. Patients and Methods: Patients with rheumatic diseases receiving GCs (≥0.5 mg/kg/day for prednisolone equivalent) within the past 2 months were enrolled in this study, and treated with 200 mg/day of etidronate cyclically. The bone mineral density (BMD) of the lumbar spine (L2-4) was examined by QDR2000. OFH was evaluated by magnetic resonance imaging (MRI). [ClinicalTrials.gov identifier: NCT00679978]. Results: Forty-four patients completed the 2-year study including annual X-rays and the BMD analysis. MRI evaluation at entry and 2 years was performed in 41 patients. The BMD values with anteroposterior (AP) and lateral views decreased by 6.4{\%} and 9.7{\%}, respectively, in the first year, but were stable in the second year. Eleven patients developed VF and 9 patients developed OFH. The risk factors for VF included previous VF and a low BMD value (T score<-1.5) of AP view at baseline with an odds ratio (OR) of 14.9 (95{\%} CI 2.9-76.4), while the risk factor for OFH was a recent maximum GC dosage (>1.2 mg/kg/day versus≤; OR=7.7, 95{\%}CI 1.3-45.5) and a decrease in BMD value of lateral view (>15{\%} versus≤ OR=6.7, 95{\%} CI 1.2-36.1) in the first year. Conclusion: The development of VF relies on the predisposing factors, while that of OFH depends on the response to high-dose GC therapy.",
keywords = "Aseptic necrosis, Corticosteroids, Osteoporosis, Systemic lupus erythematosus",
author = "Hideto Kameda and Koichi Amano and Hayato Nagasawa and Hiroe Ogawa and Naoya Sekiguchi and Hirofumi Takei and Katsuya Suzuki and Tsutomu Takeuchi",
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T1 - Notable difference between the development of vertebral fracture and osteonecrosis of the femoral head in patients treated with high-dose glucocorticoids for systemic rheumatic diseases

AU - Kameda, Hideto

AU - Amano, Koichi

AU - Nagasawa, Hayato

AU - Ogawa, Hiroe

AU - Sekiguchi, Naoya

AU - Takei, Hirofumi

AU - Suzuki, Katsuya

AU - Takeuchi, Tsutomu

PY - 2009

Y1 - 2009

N2 - Objective: Vertebral fracture (VF) and osteonecrosis of the femoral head (OFH) are serious concerns in patients with rheumatic diseases treated with high-dose glucocorticoids (GCs). We comparatively examined the risk factors of VF and OFH in patients who had recently received high-dose GC therapy. Patients and Methods: Patients with rheumatic diseases receiving GCs (≥0.5 mg/kg/day for prednisolone equivalent) within the past 2 months were enrolled in this study, and treated with 200 mg/day of etidronate cyclically. The bone mineral density (BMD) of the lumbar spine (L2-4) was examined by QDR2000. OFH was evaluated by magnetic resonance imaging (MRI). [ClinicalTrials.gov identifier: NCT00679978]. Results: Forty-four patients completed the 2-year study including annual X-rays and the BMD analysis. MRI evaluation at entry and 2 years was performed in 41 patients. The BMD values with anteroposterior (AP) and lateral views decreased by 6.4% and 9.7%, respectively, in the first year, but were stable in the second year. Eleven patients developed VF and 9 patients developed OFH. The risk factors for VF included previous VF and a low BMD value (T score<-1.5) of AP view at baseline with an odds ratio (OR) of 14.9 (95% CI 2.9-76.4), while the risk factor for OFH was a recent maximum GC dosage (>1.2 mg/kg/day versus≤; OR=7.7, 95%CI 1.3-45.5) and a decrease in BMD value of lateral view (>15% versus≤ OR=6.7, 95% CI 1.2-36.1) in the first year. Conclusion: The development of VF relies on the predisposing factors, while that of OFH depends on the response to high-dose GC therapy.

AB - Objective: Vertebral fracture (VF) and osteonecrosis of the femoral head (OFH) are serious concerns in patients with rheumatic diseases treated with high-dose glucocorticoids (GCs). We comparatively examined the risk factors of VF and OFH in patients who had recently received high-dose GC therapy. Patients and Methods: Patients with rheumatic diseases receiving GCs (≥0.5 mg/kg/day for prednisolone equivalent) within the past 2 months were enrolled in this study, and treated with 200 mg/day of etidronate cyclically. The bone mineral density (BMD) of the lumbar spine (L2-4) was examined by QDR2000. OFH was evaluated by magnetic resonance imaging (MRI). [ClinicalTrials.gov identifier: NCT00679978]. Results: Forty-four patients completed the 2-year study including annual X-rays and the BMD analysis. MRI evaluation at entry and 2 years was performed in 41 patients. The BMD values with anteroposterior (AP) and lateral views decreased by 6.4% and 9.7%, respectively, in the first year, but were stable in the second year. Eleven patients developed VF and 9 patients developed OFH. The risk factors for VF included previous VF and a low BMD value (T score<-1.5) of AP view at baseline with an odds ratio (OR) of 14.9 (95% CI 2.9-76.4), while the risk factor for OFH was a recent maximum GC dosage (>1.2 mg/kg/day versus≤; OR=7.7, 95%CI 1.3-45.5) and a decrease in BMD value of lateral view (>15% versus≤ OR=6.7, 95% CI 1.2-36.1) in the first year. Conclusion: The development of VF relies on the predisposing factors, while that of OFH depends on the response to high-dose GC therapy.

KW - Aseptic necrosis

KW - Corticosteroids

KW - Osteoporosis

KW - Systemic lupus erythematosus

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