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.
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