Assessment of Bone Quality by Trabecular Bone Score (TBS) in Systemic Lupus Erythematosus Patients

Andrea Casabella ¹, Sabrina Paolino ², Alberto Sulli³, Elisa Alessandri ⁴, Vanessa Smith ⁵, Barbara Ruaro ⁶, Carmen Pizzorni ² and Maurizio Cutolo ⁷, ¹1 Research Laboratory and Academic Division of the Clinical Rheumatology Department of Internal Medicine, University of Genova, IRCCS San Martino Polyclinic Hospital, Genoa, Italy, Genoa, Italy, ²Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS San Martino Polyclinic Hospital, Genoa, Italy, Genoa, Italy, ³Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS Ospedale Policlinico San Martino, Genoa, Italy, Genoa, Italy, ⁴Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS San Martino Polyclinic Hospital, Genoa, Italy, Genova, ⁵Dept. of Rheumatology, Ghent University Hospital, Ghent, Belgium; Dept. of Internal Medicine, Ghent University, Ghent, Belgium; Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium, Gent, Belgium, ⁶1 Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; 2 Cardinal Ferrari Centre, S. Stefano Rheabilitation, Fontanellato (Parma), Italy, Genoa, Italy, ⁷Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS Ospedale Policlinico San Martino, Genoa, Italy, Genoa, Italy

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: bone density and bone quality, osteoporosis, Systemic lupus erythematosus (SLE), trabecular bone score

Session Information

Date: Tuesday, November 12, 2019

Title: Osteoporosis & Metabolic Bone Disease – Basic & Clinical Science Poster

Session Type: Poster Session (Tuesday)

Session Time: 9:00AM-11:00AM

Background/Purpose: Systemic lupus erythematosus (SLE) patients show an increased risk of low bone mass as a result of multifactorial events: physical inactivity, persistent inflammation, low vitamin D levels (protection to avoid photosensitivity) and glucocorticoid treatment. Trabecular Bone Score (TBS) is an index extracted from the dual-energy X-ray absorptiometry (DXA) that provides an indirect measurement of bone axial microarchitecture and allows to get information about bone quality in several rheumatic diseases (1-4).
The aims of this study was to examine the prevalence and risk factors for low bone mineral density (BMD) (osteoporosis or osteopenia) in female patients affected by SLE in comparison with matched healthy subjects (HS).

Methods: 60 female patients (mean age 45±16 years) affected by SLE and 60 age- matched CNT (mean age 47±5 years) were enrolled. Bone Mineral Density (BMD, g/cm2) of the lumbar spine (L1-L4) was analyzed using a DXA scan (GE, Lunar Prodigy). Lumbar spine TBS was derived for each spine DXA examination using the TBS index (TBS iNsight Medimaps).

Results: The mean BMD was 0.49±0.41 SD g/cm² at the lumbar spine and 0.59±0.62 g/cm² at the hip in SLE patients. The prevalence of osteopenia and osteoporosis in SLE patients was 39.0% and 16.4% respectively. Most of SLE patients (70%) presented a bone loss that was significantly lower when compared with control group (p< 0.001). Likewise, lumbar spine TBS score was found significantly lower in SLE patients compared with HS (0.797±0.825 vs 1.398±0.207, p< 0.001, respectively). An history of high-dose oral glucocorticoids ( > 10 mg/day) was found associated with the preservation of BMD at the lumbar spine but not in spinal trabecular bone as observed by TBS analysis.

Conclusion: SLE is associated with significant trabecular bone loss, which might not be caused by glucocorticoid therapy. This study underlines the role of TBS as new and safe diagnostic tool for the quantification of the bone quality in chronic and systemic inflammatory rheumatic diseases, such as SLE.
References: 1 Cutolo M, et al. Ann Rheum Dis. 2009;68:446-7; 2 Dey M, et al. Lupus. 2018;27:1547-51; 3 Ruaro B, et al. Rheumatology (Oxford). 2018;57:1548-54. 4 Ruaro B, et al. Clin Rheumatol. 2018;373057-62.

Disclosure: A. Casabella, None; S. Paolino, None; A. Sulli, None; E. Alessandri, None; V. Smith, None; B. Ruaro, None; C. Pizzorni, None; M. Cutolo, Boehringer, Actelion, Celgene, Bristol-Mayer Squibb, 2.

To cite this abstract in AMA style:

Casabella A, Paolino S, Sulli A, Alessandri E, Smith V, Ruaro B, Pizzorni C, Cutolo M. Assessment of Bone Quality by Trabecular Bone Score (TBS) in Systemic Lupus Erythematosus Patients [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/assessment-of-bone-quality-by-trabecular-bone-score-tbs-in-systemic-lupus-erythematosus-patients/. Accessed .

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