Abstract：
BACKGROUND: Femoral localized periosteal thickening (LPT, also termed \"beaking\") of the lateral cortex often precedes an atypical femoral fracture (AFF). Bisphosphonate (BP) use, glucocorticoid use, and Asian race are major risk factors for developing such fractures. The aim of this study was to determine whether the trabecular bone score (TBS) reflecting the lumbar trabecular microarchitecture was related to LPT in glucocorticoid-treated Japanese patients with autoimmune diseases.
METHODS: We retrospectively investigated 111 women with autoimmune diseases treated with prednisolone (PSL) who had undergone both femoral X-ray and dual-energy X-ray absorptiometry of the L1 - L4 lumbar vertebrae and for whom TBS could be evaluated for two or more of these.
RESULTS: Femoral LPT was evident in the X-rays of 18 of 111 patients (16.2%). Higher body mass index (BMI), longer duration of PSL use and longer duration of BP use were significant in patients with LPT compared to those without. The TBS was significantly lower in patients with LPT than in those without (1.314 ± 0.092 vs. 1.365 ± 0.100, p = 0.044); however, the lumbar bone mineral density did not differ significantly (0.892 ± 0.141 vs. 0.897 ± 0.154 g/cm2, p = 0.897). TBS was significantly associated with LPT (odds ratio, 0.004; 95% CI, 0 - 0.96; p = 0.048), but not in the multivariate analysis including BMI, duration of PSL use and duration of BP use.
CONCLUSIONS: The TBS was lower in glucocorticoid-treated Japanese women with autoimmune diseases with LPT than in those without LPT, and deteriorated trabecular microarchitecture influenced by longer use of BP and glucocorticoid might be associated with the development of LPT.
METHODS: We retrospectively investigated 111 women with autoimmune diseases treated with prednisolone (PSL) who had undergone both femoral X-ray and dual-energy X-ray absorptiometry of the L1 - L4 lumbar vertebrae and for whom TBS could be evaluated for two or more of these.
RESULTS: Femoral LPT was evident in the X-rays of 18 of 111 patients (16.2%). Higher body mass index (BMI), longer duration of PSL use and longer duration of BP use were significant in patients with LPT compared to those without. The TBS was significantly lower in patients with LPT than in those without (1.314 ± 0.092 vs. 1.365 ± 0.100, p = 0.044); however, the lumbar bone mineral density did not differ significantly (0.892 ± 0.141 vs. 0.897 ± 0.154 g/cm2, p = 0.897). TBS was significantly associated with LPT (odds ratio, 0.004; 95% CI, 0 - 0.96; p = 0.048), but not in the multivariate analysis including BMI, duration of PSL use and duration of BP use.
CONCLUSIONS: The TBS was lower in glucocorticoid-treated Japanese women with autoimmune diseases with LPT than in those without LPT, and deteriorated trabecular microarchitecture influenced by longer use of BP and glucocorticoid might be associated with the development of LPT.
摘要：
背景：股骨局部骨膜增厚（LPT，也称为“喙”）的外侧皮质通常先于非典型股骨骨折（AFF）。双膦酸盐（BP）的使用，糖皮质激素的使用，和亚洲种族是发生此类骨折的主要危险因素。这项研究的目的是确定在接受糖皮质激素治疗的日本自身免疫性疾病患者中，反映腰椎小梁微结构的骨小梁评分（TBS）是否与LPT相关。
方法：我们回顾性调查了111名接受泼尼松龙（PSL）治疗的自身免疫性疾病的妇女，她们接受了L1-L4腰椎的股骨X线和双能X线吸收测定，并且可以对其中两种或多种TBS进行评估。
结果：在111例患者中有18例（16.2%）的X线片中，股骨LPT明显。较高的体重指数（BMI），与没有LPT的患者相比,有LPT的患者使用PSL的持续时间更长和使用BP的持续时间更长是显著的.LPT患者的TBS明显低于无LPT患者（1.314±0.092vs.1.365±0.100，p=0.044)；然而，腰椎骨密度没有显着差异（0.892±0.141vs.0.897±0.154g/cm2，p=0.897）。TBS与LPT显著相关(比值比，0.004；95%CI，0-0.96；p=0.048），但在包括BMI在内的多变量分析中却没有，PSL使用的持续时间和BP使用的持续时间。
结论：接受糖皮质激素治疗的日本女性自身免疫性疾病伴LPT患者的TBS低于无LPT患者，长期使用BP和糖皮质激素影响小梁微结构的恶化可能与LPT的发展有关。
方法：我们回顾性调查了111名接受泼尼松龙（PSL）治疗的自身免疫性疾病的妇女，她们接受了L1-L4腰椎的股骨X线和双能X线吸收测定，并且可以对其中两种或多种TBS进行评估。
结果：在111例患者中有18例（16.2%）的X线片中，股骨LPT明显。较高的体重指数（BMI），与没有LPT的患者相比,有LPT的患者使用PSL的持续时间更长和使用BP的持续时间更长是显著的.LPT患者的TBS明显低于无LPT患者（1.314±0.092vs.1.365±0.100，p=0.044)；然而，腰椎骨密度没有显着差异（0.892±0.141vs.0.897±0.154g/cm2，p=0.897）。TBS与LPT显著相关(比值比，0.004；95%CI，0-0.96；p=0.048），但在包括BMI在内的多变量分析中却没有，PSL使用的持续时间和BP使用的持续时间。
结论：接受糖皮质激素治疗的日本女性自身免疫性疾病伴LPT患者的TBS低于无LPT患者，长期使用BP和糖皮质激素影响小梁微结构的恶化可能与LPT的发展有关。
