The effect of rectally administered steroids on bone turnover: a comparative study.
BACKGROUND
Oral glucocorticoids contribute significantly to the risk of osteoporosis in patients with inflammatory bowel disease. Less well established are the effects of rectally administered steroids on bone metabolism.


OBJECTIVE
To investigate the effects of two widely used rectal foam preparations (prednisolone metasulphobenzoate and hydrocortisone acetate) on biochemical markers of bone turnover.


METHODS
Twenty-four patients with active inflammatory bowel disease randomly received a standard course of either prednisolone metasulphobenzoate or hydrocortisone acetate for 2 weeks. Biochemical markers of bone turnover were measured before, during and after treatment. Bone formation markers measured were serum osteocalcin (BGP) and bone-specific alkaline phosphatase (BALP). Urinary deoxypyridinoline (DPD) was measured to assess bone resorption.


RESULTS
Disease activity scores improved during treatment (difference in mean Powell-Tuck score = 3.4, 95% CI: 2.0-4.8, P < 0.0001) and were similar in both hydrocortisone and prednisolone-treated groups. There was no significant reduction in BALP or BGP during treatment with either steroid preparation, and urinary DPD did not change significantly during treatment.


CONCLUSIONS
During a 2-week course of rectal hydrocortisone acetate or prednisolone metasulphobenzoate, there was no significant change in biochemical markers of bone formation or resorption. These results suggest that pharmacological doses of rectal steroid foam preparations do not significantly impair bone turnover in patients with inflammatory bowel disease.
Robinson
R J
RJ
Gastrointestinal Research Unit, Leicester General Hospital, UK.
Iqbal
S J
SJ
Wolfe
R
R
Patel
K
K
Abrams
K
K
Mayberry
J F
JF
D000285:Administration, Rectal; D000293:Adolescent; D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000187:drug effects; D000596:Amino Acids / Q000187:drug effects / Q000652:urine; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood / Q000652:urine; D001846:Bone Development / Q000187:drug effects; D016723:Bone Remodeling / Q000187:drug effects*; D001862:Bone Resorption / Q000652:urine; D001842:Bone and Bones / Q000187:drug effects / Q000378:metabolism*; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000627:therapeutic use; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015675:Osteocalcin / Q000097:blood / Q000187:drug effects; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D011446:Prospective Studies; D012720:Severity of Illness Index; D013256:Steroids / Q000008:administration & dosage / Q000627:therapeutic use*; D013997:Time Factors
D000596:Amino Acids; D000893:Anti-Inflammatory Agents; D015415:Biomarkers; D013256:Steroids; D015675:Osteocalcin; C036020:deoxypyridinoline; D011239:Prednisolone; D000469:Alkaline Phosphatase; D006854:Hydrocortisone