Background: Glucocorticoid induced osteoporosis is the most common form of secondary osteoporosis. The high risk of fractures and their consequences on back pain and quality of life must induce a previously take of care. A method to detect vertebral fracture (VF) use dual-energy X-ray absorptiometry (DXA), also known as vertebral fracture assessment (VFA). The aim of our study was to evaluate the interest of introducing VFA at the same time of bone densitometry for all patients who begin a glucocorticoid therapy as less as 7,5mg per day for more than 3 months. The patient support was based on the last recommendations of managing glucocorticoid induced osteoporosis in France, GRIO (Group of Research and Information of Osteoporosis) which are quite similar to the European guidelines.
Methods: Transversal study in the university hospital of Limoges, France. Patients with previous VF, discarthrosis or serious scoliosis were excluded. We collected usual risk factors of osteoporosis, comorbidity, and modality of glucocorticoid therapy with a questionnaire and obtain the BMD measurements and T-score (neck of hip and lumbar spine) with a bone densitometer (Lunar iDXA). All VFA were analysed by two experimented readers. We used both a qualitative and semi-quantitative method (Genant) for the diagnosis of VF. In a second time, a radiography was made on patients with VF on VFA by the second reader to confirm VF and exclude a malignant aetiology.
Results: Eighty patients were included in the study: 48 women and 32 men. The mean age was 68.5 years. 11 patients had a least one VF on VFA according to the second reader. Spine radiography confirmed VF on 7 patients. Among these patients, one could obtain a treatment thanks to the presence of VF. He was a 67 years old man with T-score > -1and FRAX under the age range without any history of fragility fracture. 2 patients had an indication to teriparatide with 2 VF on VFA. Total: 10 unknown VF were diagnosed, with prevalence of VF at 8.75%. In VF group, there was significantly more lumbar colon osteoporosis and most women. PAKAB was at 0.44 (95IC 0.22-0.68).
Conclusion: Only one patient in our study had an indication to anti osteoporosiss treatment while he hadnt before VFA. Two patients had a change of their treatment with teriparatide. VFA allowed a change in management of glucocorticoid-induced osteoporosis in 3 patients. Prevalence of VF was lower than literature knowledge partly because VF was an exclusion criteria in our study. Difference between two readers was on mens VFA and mild VF that is also known in the literature. VFA may overstate the prevalence of mild VF. VFA at baseline of management of glucocorticoid-induced osteoporosis change our support in less of 5%. But VF on VFA is very important for patients monitoring as absence of VF.
Disclosure: The authors declared no competing interests.