Background Prolonged corticosteroid therapy increases the riskof osteoporosis and fracture. We studied whether corticosteroid-inducedosteoporosis could be prevented by treatment with calcium, calcitriol(1,25-dihydroxyvitamin D3), and calcitonin.
Methods One hundred three patients starting long-term corticosteroidtherapy were randomly assigned to receive 1000 mg of calciumper day orally and either calcitriol (0.5 to 1.0 µg perday orally) plus salmon calcitonin (400 IU per day intranasally),calcitriol plus a placebo nasal spray, or double placebo forone year. Data on treatment efficacy were available for 92 ofthese patients. Bone density was measured every four monthsfor two years by photon absorptiometry. There were no significantdifferences between groups with respect to age, underlying disease,initial bone density, or corticosteroid dose during the firstyear.
Results Calcitriol (mean dose, 0.6 µg per day), with orwithout calcitonin, prevented more bone loss from the lumbarspine (mean rates of change, -0.2 and -1.3 percent per year,respectively) than calcium alone (-4.3 percent per year, P =0.0035). Bone loss at the femoral neck and distal radius wasnot significantly affected by any treatment. In the second year,lumbar bone loss did not occur in the group previously treatedwith calcitonin plus calcitriol (+0.7 percent per year), butit did occur in the group given calcium alone (-2.3 percentper year). The calcitriol group also lost lumbar bone (-3.6percent per year) but received more corticosteroid in the secondyear than the other two groups.
Conclusions Calcitriol and calcium, used prophylactically withor without calcitonin, prevent corticosteroid-induced bone lossin the lumbar spine.
Source Information
From the Bone and Mineral Research Division, Garvan Institute of Medical Research (P.S., J.B., P.K., S.K., T.N., J.E.), and the Departments of Endocrinology (P.K., J.E.), Nuclear Medicine (N.P.), Rheumatology (P.S., S.K.), and Gerontology (P.S.), St. Vincent's Hospital and the Schools of Medicine (P.S., P.K., N.P., J.E.) and Community Medicine (P.S.), University of New South Wales, Sydney, Australia.
Address reprint requests to Dr. Sambrook at the Bone and Mineral Research Division, Garvan Institute of Medical Research, St. Vincent's Hospital, Darlinghurst, NSW 2010, Australia.
Toussaint, N. D., Elder, G. J., Kerr, P. G.
(2009). Bisphosphonates in Chronic Kidney Disease; Balancing Potential Benefits and Adverse Effects on Bone and Soft Tissue. CJASN
4: 221-233
[Abstract][Full Text]
Bertsias, G, Ioannidis, J P A, Boletis, J, Bombardieri, S, Cervera, R, Dostal, C, Font, J, Gilboe, I M, Houssiau, F, Huizinga, T, Isenberg, D, Kallenberg, C G M, Khamashta, M, Piette, J C, Schneider, M, Smolen, J, Sturfelt, G, Tincani, A, van Vollenhoven, R, Gordon, C, Boumpas, D T
(2008). EULAR recommendations for the management of systemic lupus erythematosus. Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics. Ann Rheum Dis
67: 195-205
[Abstract][Full Text]
Schueller-Weidekamm, C., Krestan, C., Schueller, G., Kapral, T., Aletaha, D., Kainberger, F.
(2007). Power Doppler Sonography and Pulse-Inversion Harmonic Imaging in Evaluation of Rheumatoid Arthritis Synovitis. Am. J. Roentgenol.
188: 504-508
[Abstract][Full Text]
Shah, S. K., Gecys, G. T.
(2006). Prednisone-Induced Osteoporosis: An Overlooked and Undertreated Adverse Effect. JAOA: Journal of the American Osteopathic Association
106: 653-657
[Abstract][Full Text]
Gulati, S., Sharma, R. K., Gulati, K., Singh, U., Srivastava, A.
(2005). Longitudinal follow-up of bone mineral density in children with nephrotic syndrome and the role of calcium and vitamin D supplements. Nephrol Dial Transplant
20: 1598-1603
[Abstract][Full Text]
Bergland, A, Wyller, T B
(2004). Risk factors for serious fall related injury in elderly women living at home. Inj. Prev.
10: 308-313
[Abstract][Full Text]
Shane, E., Addesso, V., Namerow, P. B., McMahon, D. J., Lo, S.-H., Staron, R. B., Zucker, M., Pardi, S., Maybaum, S., Mancini, D.
(2004). Alendronate versus Calcitriol for the Prevention of Bone Loss after Cardiac Transplantation. NEJM
350: 767-776
[Abstract][Full Text]
Adler, R. A., Hochberg, M. C.
(2003). Suggested Guidelines for Evaluation and Treatment of Glucocorticoid-Induced Osteoporosis for the Department of Veterans Affairs. Arch Intern Med
163: 2619-2624
[Abstract][Full Text]
El-Agroudy, A. E., El-Husseini, A. A., El-Sayed, M., Ghoneim, M. A.
(2003). Preventing Bone Loss in Renal Transplant Recipients with Vitamin D. J. Am. Soc. Nephrol.
14: 2975-2979
[Abstract][Full Text]
Yeap, S. S., Hosking, D. J.
(2002). Management of corticosteroid-induced osteoporosis. Rheumatology (Oxford)
41: 1088-1094
[Abstract][Full Text]
de Sevaux, R. G. L., Hoitsma, A. J., Corstens, F. H. M., Wetzels, J. F. M.
(2002). Treatment with Vitamin D and Calcium Reduces Bone Loss after Renal Transplantation: A Randomized Study. J. Am. Soc. Nephrol.
13: 1608-1614
[Abstract][Full Text]
Biskobing, D. M.
(2002). COPD and Osteoporosis. Chest
121: 609-620
[Abstract][Full Text]
Yosipovitch, G., Hoon, T. S., Leok, G. C.
(2001). Suggested Rationale for Prevention and Treatment of Glucocorticoid-Induced Bone Loss in Dermatologic Patients. Arch Dermatol
137: 477-481
[Abstract][Full Text]
Reid, I. R.
(2001). Time to End Steroid-Induced Fractures. Arch Dermatol
137: 493-494
[Full Text]
Sen, D, Keen, R W
(2001). Osteoporosis in systemic lupus erythematosus: prevention and treatment. Lupus
10: 227-232
[Abstract]
Conron, M., Young, C., Beynon, H. L. C.
(2000). Calcium metabolism in sarcoidosis and its clinical implications. Rheumatology (Oxford)
39: 707-713
[Abstract][Full Text]
LLOYD, M E, SPECTOR, T D, HOWARD, R
(2000). Osteoporosis in neurological disorders. J. Neurol. Neurosurg. Psychiatry
68: 543-547
[Full Text]
Struijs, A., Smals, A., de Witte, S. A., Hackeng, W. H. L., Mulder, H.
(2000). Acute effects of etidronate on glucocorticoid-induced bone degradation. Rheumatology (Oxford)
39: 523-529
[Abstract][Full Text]
Scott, E M, Gaywood, I, Scott, B B
(2000). Guidelines for osteoporosis in coeliac disease and inflammatory bowel disease. Gut
46: I1-8
[Full Text]
Goldstein, M. F., Fallon, J. J. Jr, Harning, R.
(1999). Chronic Glucocorticoid Therapy-Induced Osteoporosis in Patients With Obstructive Lung Disease*. Chest
116: 1733-1749
[Abstract][Full Text]
Kung, A. W. C., Chan, T. M., Lau, C. S., Wong, R. W. S., Yeung, S. S. C.
(1999). Osteopenia in young hypogonadal women with systemic lupus erythematosus receiving chronic steroid therapy: a randomized controlled trial comparing calcitriol and hormonal replacement therapy. Rheumatology (Oxford)
38: 1239-1244
[Abstract][Full Text]
Reid, I. R.
(1999). Glucocorticoid Osteoporosis: Reid IR Glucocorticoid osteoporosis J Intensive Care Med 1999, 14231-242. J Intensive Care Med
14: 231-242
COMPSTON, J E
(1999). Management of bone disease in patients on long term glucocorticoid therapy. Gut
44: 770-772
[Full Text]
Lips, P.
(1999). Prevention of corticosteroid induced osteoporosis. BMJ
318: 1366-1367
[Full Text]
Kanis, J.A., McCloskey, E.V.
(1999). Effect of calcitonin on vertebral and other fractures. QJM
92: 143-150
[Abstract][Full Text]
Cremer, J., Struber, M., Wagenbreth, I., Nischelsky, J., Demertzis, S., Graeter, T., Abraham, C., Haverich, A.
(1999). Progression of steroid-associated osteoporosis after heart transplantation. Ann. Thorac. Surg.
67: 130-133
[Abstract][Full Text]
Geusens, P., Dequeker, J., Vanhoof, J., Stalmans, R., Boonen, S., Joly, J., Nijs, J., Raus, J.
(1998). Cyclical etidronate increases bone density in the spine and hip of postmenopausal women receiving long term corticosteroid treatment. A double blind, randomised placebo controlled study. Ann Rheum Dis
57: 724-727
[Abstract][Full Text]
Saag, K. G., Emkey, R., Schnitzer, T. J., Brown, J. P., Hawkins, F., Goemaere, S., Thamsborg, G., Liberman, U. A., Delmas, P. D., Malice, M.-P., Czachur, M., Daifotis, A. G., Lane, N., Correa-Rotter, R., Yanover, M., Westhovens, R., Epstein, S., Adachi, J. D., Poubelle, P., Melo-Gomes, J., Rodriguez-Portales, J. A., The Glucocorticoid-Induced Osteoporosis Interventi,
(1998). Alendronate for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis. NEJM
339: 292-299
[Abstract][Full Text]
Reid, I. R.
(1998). Glucocorticoid Effects on Bone. J. Clin. Endocrinol. Metab.
83: 1860-1862
[Full Text]
STANBURY, R. M, GRAHAM, E. M
(1998). Systemic corticosteroid therapy---side effects and their management. Br. J. Ophthalmol.
82: 704-708
[Full Text]
Pitt, P, Li, F, Todd, P, Webber, D, Pack, S, Moniz, C
(1998). A double blind placebo controlled study to determine the effects of intermittent cyclical etidronate on bone mineral density in patients on long term oral corticosteroid treatment. Thorax
53: 351-356
[Abstract][Full Text]
Rizzato, G.
(1998). Clinical impact of bone and calcium metabolism changes in sarcoidosis. Thorax
53: 425-429
[Full Text]
Roux, C., Oriente, P., Laan, R., Hughes, R. A., Ittner, J., Goemaere, S., Di Munno, O., Pouillès, J. M., Horlait, S., Cortet, B.
(1998). Randomized Trial of Effect of Cyclical Etidronate in the Prevention of Corticosteroid-Induced Bone Loss. J. Clin. Endocrinol. Metab.
83: 1128-1133
[Abstract][Full Text]
Boot, A M, Bouquet, J, Krenning, E P, de Muinck Keizer-Schrama, S M P F
(1998). Bone mineral density and nutritional status in children with chronic inflammatory bowel disease. Gut
42: 188-194
[Abstract][Full Text]
Gussinye, M., Carrascosa, A., Potau, N., Enrubia, M., Vicens-Calvet, E., Ibanez, L., Yeste, D.
(1997). Bone Mineral Density in Prepubertal and in Adolescent and Young Adult Patients With the Salt-wasting Form of Congenital Adrenal Hyperplasia. Pediatrics
100: 671-674
[Abstract][Full Text]
Adachi, J. D., Bensen, W. G., Brown, J., Hanley, D., Hodsman, A., Josse, R., Kendler, D. L., Lentle, B., Olszynski, W., Ste.-Marie, L.-G., Tenenhouse, A., Chines, A. A., Jovaisas, A., Sturtridge, W. C., Anastassiades, T. P., Hanly, J. G., Pope, J. E., Dias, R., Horowitz, Z. D., Pack, S.
(1997). Intermittent Etidronate Therapy to Prevent Corticosteroid-Induced Osteoporosis. NEJM
337: 382-388
[Abstract][Full Text]
Reid, I. R.
(1997). Preventing Glucocorticoid-Induced Osteoporosis. NEJM
337: 419-421
[Full Text]
Lems, W. F, Jacobs, J. W G, Bijlsma, J. W J, van Veen, G. J M, Houben, H. H M L, Haanen, H. C M, Gerrits, M. I, van Rijn, H. J M
(1997). Is addition of sodium fluoride to cyclical etidronate beneficial in the treatment of corticosteroid induced osteoporosis?. Ann Rheum Dis
56: 357-363
[Abstract][Full Text]
Walsh, L J, Wong, C A, Pringle, M, Tattersfield, A E
(1996). Use of oral corticosteroids in the community and the prevention of secondary osteoporosis: a cross sectional study. BMJ
313: 344-346
[Abstract][Full Text]
Reid, I. R., Wattie, D. J., Evans, M. C., Stapleton, J. P.
(1996). Testosterone Therapy in Glucocorticoid-Treated Men. Arch Intern Med
156: 1173-1177
[Abstract]
Sels, F., Dequeker, J., Verwilghen, J., Mbuyi-Muamba, J-M.
(1996). SLE and osteoporosis: dependence and/or independence on glucocorticoids. Lupus
5: 89-92
Herings, R. M. C., Stricker, B. H. Ch., de Boer, A., Bakker, A., Sturmans, F.
(1995). Benzodiazepines and the Risk of Falling Leading to Femur Fractures: Dosage More Important Than Elimination Half-life. Arch Intern Med
155: 1801-1807
[Abstract]
George, J. N., El-Harake, M. A., Raskob, G. E.
(1994). Chronic Idiopathic Thrombocytopenic Purpura. NEJM
331: 1207-1211
[Full Text]
Jones, G, Nguyen, T, Sambrook, P, Kelly, P J, Eisman, J A
(1994). Progressive loss of bone in the femoral neck in elderly people: longitudinal findings from the Dubbo osteoporosis epidemiology study. BMJ
309: 691-695
[Abstract][Full Text]
(1993). CALCITRIOL PLUS CALCIUM PREVENTS STEROID-INDUCED BONE LOSS. JWatch General
1993: 4-4
[Full Text]
Meunier, P. J.
(1993). Is Steroid-Induced Osteoporosis Preventable?. NEJM
328: 1781-1782
[Full Text]
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