1. Bone Density, Skin Thickness and Intervertebral Disc Height in Postmenopausal Women on Long-Term Corticosteroids
Dr Y Muscat Baron MD, FRCOG, MRCPI, Ph.D.
Dr R Galea MD, FRCOG.
Prof. M Brincat FRCOG, FRCPI, Ph.D.
DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY ST.LUKE’S HOSPITAL MALTA

2. Introduction
Long-term corticosteroids are useful anti-inflammatory agents, but are associated with a number of side-effects including osteoporosis and skin thinning. Cushing 1932 Hench 1949 Finlay 1999
Bone, skin, and the intervertebral discs have a high connective tissue content which may be adversely affected by corticosteroids.
The menopause has similarly shown deleterious effects on the connective tissue element.

3. Patients and Methods
64 postmenopausal women on long-term corticosteroids were recruited and compared to a control menopausal group, fracture group and a group of women on HRT.
The skin thickness was measured with a 22.5MHz Ultrasound probe- Osteoson DIII.
The bone density was measured with a Norland Bone Densitometer XR 586.
Intervertebral Disc Height was measured by applying the bone densitometer vertebral body height cursors to the edges of the discs.
The adjacent greyscale was used to increase accuracy of measurement.

4. Breakdown of Chronic Diseases requiring Long-Term Corticosteroids
Medical Condition
Rheumatoid Arthritis
Bronchial Asthma
S.L.E.
Ulcerative Colitis
Crohn’s Disease
Renal Transplant
Sarcoidosis
Addison’s Disease
Lung Fibrosis
Sjogren’s Syndrome
Scleroderma
Hypogammglobulinaemia
Number of Patients 28 21 3 4 1

5. Patient Data for Cross-sectional Study
Controls
Menop Group
OsteoporFractures Group
HRT Group
Cortico Steroid Therapy
Patients (n)
557
180
399 64
Mean Age (years)
(+/-8.8)
67 (+/-11.9)
56 (+/-7.8)
53 (+/-7.5)
Mean Age of Menop
47.5 (+/-5.5)
47.3 (+/-10.2)
(+/-5.6)
(+/-6.5)

6. LUMBAR BONE DENSITY (L2-L4)
***
***
*** p <

7. ***
***
*** p <

11. ***
***
*** p <

12. ***
***
HRT and Menstr vs Steroids, Fract, Menop p <

13. Patient Data for Longitudinal Study
HRT
No Adjunctive Therapy
Patients (n) 12 17
Mean Age (Years)
(+/- 10)
(+/-7.0)
Mean Age of Menopause
(+/-4.0)
(+/-3.5)

14. PERCENTAGE CHANGE IN BONE DENSITY OF L2-L4*
* P < 0.05
HRT
UNTREATED

15. *
* P < 0.05

16. Percentage Change *
* P < 0.05

17. INTERVERTEBRAL DISC D2 THICKNESS (HRT Steroid Rx)
Disc Thickness
Years on HRT

18. INTERVERTEBRAL DISC D2 HEIGHT (Corticosteroid Rx, Not on HRT)
Disc Height cm
UNTREATED
Years

19. INTERVERTEBRAL DISC D2 HEIGHT (Corticosteroid Rx,)
Disc Height cm *
HRT
UNTREATED
*P < 0.05
Years

22. Long- Term Steroid Therapy
Cushing’s Disease
Long- Term Steroid Therapy

24. Conclusion
Long-term corticosteroid therapy appears to augment the deleterious effects of the menopause on skin thickness, bone density and intervertebral disc height.
These effects may be mediated through the influence on the connective tissue components.
Hormone replacement therapy appears to reverse skin thinning, osteoporosis and loss in disc height.
HRT may be a useful adjunct for menopausal women on long-term corticosteroids.