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Previous Volume 337:382-388 August 7, 1997 Number 6 Next

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ABSTRACT

Background and Methods Osteoporosis is a recognized complication of corticosteroid therapy. Whether it can be prevented is not known. We conducted a 12-month, randomized, placebo-controlled study of intermittent etidronate (400 mg per day for 14 days) followed by calcium (500 mg per day for 76 days), given for four cycles, in 141 men and women (age, 19 to 87 years) who had recently begun high-dose corticosteroid therapy. The primary outcome measure was the difference in the change in the bone density of the lumbar spine between the groups from base line to week 52. Secondary measures included changes in the bone density of the femoral neck, trochanter, and radius and the rate of new vertebral fractures.

Results The mean (±SE) bone density of the lumbar spine and trochanter in the etidronate group increased 0.61±0.54 and 1.46±0.67 percent, respectively, as compared with decreases of 3.23±0.60 and 2.74±0.66 percent, respectively, in the placebo group. The mean differences between the groups after one year were 3.72±0.88 percentage points for the lumbar spine (P = 0.02) and 4.14±0.94 percentage points for the trochanter (P = 0.02). The changes in the femoral neck and the radius were not significantly different between the groups. There was an 85 percent reduction in the proportion of postmenopausal women with new vertebral fractures in the etidronate group as compared with the placebo group (1 of 31 patients vs. 7 of 32 patients, P = 0.05), and the etidronate-treated postmenopausal women also had significantly fewer vertebral fractures per patient (P = 0.04).

Conclusions Intermittent etidronate therapy prevents the loss of vertebral and trochanteric bone in corticosteroid-treated patients.

Source Information

From the Department of Medicine, St. Joseph's Hospital, McMaster University, Hamilton, Ont. (J.D.A., W.G.B.); the Centre Hospitalier de l'Université Laval, Ste.-Foy, Que. (J.B.); Foothills Hospital, University of Calgary, Calgary, Alta. (D.H.); St. Joseph's Hospital and Victoria General Hospital, University of Western Ontario, London (A.H.); St. Michael's Hospital and Toronto General Hospital, University of Toronto, Toronto (R.J.); Vancouver General Hospital, University of British Columbia, Vancouver (D.L.K., B.L.); St. Paul's Hospital, University of Saskatchewan, Saskatoon (W.O.); Hôpital Saint-Luc, Université de Montréal, Montreal (L.-G.S.); and Montreal General Hospital, McGill University, Montreal (A.T.) — all in Canada; and Procter & Gamble Pharmaceuticals, Cincinnati (A.A.C.). Other authors were Algis Jovaisas, M.D. (Ottawa General Hospital, University of Ottawa, Ottawa, Ont.), William C. Sturtridge, M.D. (St. Michael's Hospital and Toronto General Hospital, University of Toronto, Toronto), Tassos P. Anastassiades, M.D. (St. Mary's of the Lake Hospital, Queen's University, Kingston, Ont.), John G. Hanly, M.D. (Victoria General Hospital, Dalhousie University, Halifax, N.S.), Janet E. Pope, M.D. (Victoria General Hospital, University of Western Ontario, London), and Reginald Dias, B.Sc., Zebulun D. Horowitz, M.D., and Simon Pack, Ph.D. (Procter & Gamble Pharmaceuticals, Cincinnati).

Address reprint requests to Dr. Adachi at 501–25 Charlton Ave. E., Hamilton, ON L8N 1Y2, Canada.

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