# Translation of Hip Microarchitectural Assessment Technology to the Clinic to Diagnose Glucocorticoid-Induced Osteoporosis

> **NIH NIH R01** · NEW YORK UNIVERSITY SCHOOL OF MEDICINE · 2020 · $517,750

## Abstract

Project Summary
Glucocorticoid-induced osteoporosis (GIO) is the most common secondary form of osteoporosis.
Glucocorticoid users are at a higher risk for all types of fragility fractures compared to non-users. Effective
medications exist that can reduce fracture risk in GIO. However, standard-of-care methods used to diagnose
osteoporosis – dual-energy x-ray absorptiometry (DXA) estimation of areal bone mineral density (BMD) and
FRAX – underestimate fracture risk in glucocorticoid users. As a result, GIO is under-diagnosed and under-
treated. The lack of a relationship between BMD and fracture risk in GIO means that glucocorticoids negatively
affect bone quality and strength in a way not captured by BMD. Recently, we demonstrated the feasibility of
imaging proximal femur microarchitecture in vivo on a clinical 3T MRI scanner. We have shown that such
microarchitectural assessment is reproducible and provides information about bone quality that is not captured
by DXA. We will now leverage the unique resources of Radiology (novel imaging test of proximal femur
microarchitecture) and Rheumatology (large glucocorticoid-using patient population at a lupus center nationally
known for clinical care and research) at our institution. In two specific aims, we will determine: 1) the added
value of the novel MRI test, beyond DXA, for sensitively monitoring longitudinal, detrimental changes in bone
microarchitecture and strength in the proximal femur, a standard site of BMD assessment used in FRAX and a
clinically important fracture site and 2) the value of proximal femur microarchitectural assessment, beyond that
of DXA/FRAX, for the discrimination of GIO subjects with fracture from controls without fracture. To achieve
Aim 1, we will recruit 40 lupus patients newly prescribed glucocorticoids and 40 lupus patients managed
without glucocorticoids (both as standard-of-care). We hypothesize that after adjusting for areal BMD and
disease severity, glucocorticoid users will demonstrate 12 month detrimental changes in femoral neck cortical
thickness, trabecular thickness, separation, number, connectivity, and whole femur stiffness of greater
magnitude than in controls. To achieve Aim 2, we will separately recruit 138 long-term (> 12 month),
glucocorticoid using lupus patients (expect 41 with fracture, 97 without fracture). We will build multivariate,
logistic regression models predictive of fracture status and compare the accuracy of different models (DXA,
FRAX, DXA/FRAX plus microarchitectural measures) for prediction of fracture status. We hypothesize that the
addition of microarchitectural measures to DXA/FRAX will improve model accuracy for prediction of fracture
status compared to DXA/FRAX alone. Successful execution of this project will demonstrate the feasibility of
detecting currently occult, skeletally fragile glucocorticoid users who are in need of osteoporosis therapy. By
improving clinicians' ability to accurately diagnose GIO, we will improve clinician...

## Key facts

- **NIH application ID:** 9986664
- **Project number:** 5R01AR070131-05
- **Recipient organization:** NEW YORK UNIVERSITY SCHOOL OF MEDICINE
- **Principal Investigator:** Gregory Chang
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $517,750
- **Award type:** 5
- **Project period:** 2016-09-12 → 2022-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9986664

## Citation

> US National Institutes of Health, RePORTER application 9986664, Translation of Hip Microarchitectural Assessment Technology to the Clinic to Diagnose Glucocorticoid-Induced Osteoporosis (5R01AR070131-05). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9986664. Licensed CC0.

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