Limited bone loss due to corticosteroids; a systematic review of prospective studies in rheumatoid arthritis and other diseases.
OBJECTIVE
To clarify the relation between changes in bone density, the treated disease, and dose of corticosteroids prescribed.


METHODS
MEDLINE database (1966-95) and bibliographic searches selected cohorts of patients with rheumatoid arthritis (RA) and non-RA patients, studied by reliable serial bone density measurements.


RESULTS
Two randomized controlled trials in early RA found greater lumbar bone loss after corticosteroid treatment (pooled effect size at 6 mo 3.9%; 95% CI: 1.9, 6.0%). The other studies included 66 patients with RA taking mean 7 mg prednisone/day; 371 "untreated" RA patients; and 216 non-RA patients taking mean 20 mg prednisone/day. Lumbar bone mass changed (weighted mean) 0.0% (-0.6, 0.7%) per year in steroid treated RA, -0.6% (-0.9, -0.2%) in untreated RA, and -4.7% (-5.2, -4.3%) in non-RA. Femoral neck changed -3.0% (-4.2, -1.8%), -0.7% (-1.0, -0.3%), and -1.5% (-2.5, -0.4%), respectively. In RA, most bone was lost in the first half year, and in early or uncontrolled disease.


CONCLUSIONS
In patients with RA bone loss is limited, influenced by the interaction of disease characteristics and low dose corticosteroid therapy. In contrast, non-RA patients taking higher doses of corticosteriods may loss clinically relevant amounts of bone (i.e., > 5%) within one year.
Verhoeven
A C
AC
Department of Internal Medicine/Rheumatology, Maastricht University Hospital, The Netherlands.
Boers
M
M
D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D015519:Bone Density / Q000187:drug effects*; D015331:Cohort Studies; D005260:Female; D005272:Femur Neck / Q000187:drug effects; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008159:Lumbar Vertebrae / Q000187:drug effects; D008297:Male; D010024:Osteoporosis / Q000139:chemically induced*; D011241:Prednisone / Q000009:adverse effects* / Q000627:therapeutic use; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic
D005938:Glucocorticoids; D011241:Prednisone