Fat conversion of femoral marrow in glucocorticoid-treated patients: A cross-sectional and longitudinal study with magnetic resonance imaging

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Abstract
Objective To study the changes in hematopoietic marrow in patients given glucocorticoid (steroid) therapy. Methods In a cross‐sectional study, high‐resolution T1‐weighted magnetic resonance imaging (MRI) images of the proximal femur were obtained in an unselected series of 29 premenopausal female patients with systemic lupus erythematosus (SLE) and in a series of 29 age‐matched healthy female subjects. In a longitudinal analysis, 2 MRI studies were performed 19 months apart in 11 patients with SLE (including 9 patients from the cross‐sectional study who were evaluated before treatment) and in 7 patients with rheumatoid arthritis (RA). The percentage of fat marrow and the index of marrow conversion (IMC) were derived from the MRI images to estimate the degree of transformation of hematopoietic into fatty marrow in the area of the femoral neck. Values observed in the cross‐sectional study and their changes over time were correlated with treatment data. Results The cross‐sectional study performed in SLE patients indicated that their mean (±SD) percentage of fat marrow (48 ± 36%) and IMC (82 ± 12) were significantly more elevated than those in the healthy control subjects (18 ± 16% and 75 ± 6, respectively) (P < 0.01). The magnitude of fat conversion correlated positively with the mean daily dose of oral prednisolone, and was higher in patients with ischemic bone lesions. The longitudinal study performed in SLE and RA patients revealed that IMC changes over time correlated positively with daily prednisolone intake (r = 0.71; P = 0.001), fat conversion occurring exclusively in patients receiving a mean prednisolone dose ≤7.5 mg/day. Conclusion MRI indicates that fat conversion occurs in the proximal femur of steroid‐treated patients. The magnitude of fat conversion correlates with steroid intake and is higher in patients with ischemic bone lesions.