Bone status in glucocorticoid-treated men and women

Osteoporos Int. 2016 Jan;27(1):39-48. doi: 10.1007/s00198-015-3211-1. Epub 2015 Aug 8.


We recorded the results of areal bone mineral density (aBMD) and microarchitecture of the bone measured by trabecular bone score (TBS) in 416 glucocorticoid-treated men and women aged 40 years and older with or without fracture to 1104 controls. TBS better discriminated those with fracture compared to aBMD. These differences were the greatest in men.

Introduction: The aim of this study is to evaluate glucocorticoid (GC)-induced effects on areal bone mineral density (aBMD) and bone microarchitectural texture measured by trabecular bone score (TBS).

Methods: TBS and aBMD were evaluated at L1-L4 postero-anterior (PA) spine by dual X-ray absorptiometry (DXA) in 1520 men and women aged 40 years and over. Four hundred sixteen subjects who received GCs (≥5 mg/day, for ≥3 months) were matched with 1104 sex-, age-, and BMI-matched control subjects. Clinical data, osteoporotic fractures (OPF), and dietary habits were documented in the medical report.

Results: GC-treated patients were characterized by a significant decrease of TBS (1.267 vs. 1.298, p < 0.001) compared with control-matched subjects while no change in BMD was observed at any sites. These decreases were even more pronounced when fracture status was taken into account (1.222 vs. 1.298, p < 0.001). The odds ratio (OR) for TBS was 1.44 (1.095-1.89) for OPF, whereas no association was found for BMD at any sites (all p > 0.3). A similar effect on microarchitecture measured by TBS was seen by the presence of fracture as by the use of glucocorticoids. An influence on TBS by sex was also noted with a decrease in TBS of greater magnitude in men.

Conclusions: GC-treated individuals have a significant deterioration of bone microarchitectural texture as assessed by TBS which is more marked in those with OPF and in men. TBS seems to be more sensitive than aBMD for GC-related fracture detection and should be a good surrogate indicator of bone health in such secondary osteoporosis.

Keywords: Bone microarchitecture; DXA (dual X-ray absorptiometry); Glucocorticoid-induced osteoporosis; TBS (trabecular bone score).

MeSH terms

  • Absorptiometry, Photon / methods
  • Adult
  • Aged
  • Anthropometry / methods
  • Bone Density / drug effects
  • Case-Control Studies
  • Female
  • Glucocorticoids / adverse effects*
  • Glucocorticoids / pharmacology
  • Humans
  • Lumbar Vertebrae / drug effects
  • Lumbar Vertebrae / physiopathology
  • Male
  • Middle Aged
  • Osteoporosis / chemically induced*
  • Osteoporosis / physiopathology
  • Osteoporotic Fractures / physiopathology
  • Prednisone / adverse effects
  • Prednisone / pharmacology
  • Sex Factors


  • Glucocorticoids
  • Prednisone