[Therapy of glucocorticoid-induced osteoporosis with alfacalcidol/calcium and vitamin D/calcium].
Calcium/vitamin D supplementation is generally used as a first step treatment of glucocorticoid-induced osteoporosis (GIOP). The aim of this trial was to compare the efficacy of the D-hormone alfacalcidol with plain vitamin D in patients with established GIOP with or without vertebral fractures. Patients on long-term glucocorticoid-therapy were treated either with 1 microgram alfacalcidol plus 5000 mg calcium (group A: n = 43) or with 1000 IU vitamin D plus 500 mg calcium (group B: n = 42). The two groups were not different in respect to initial characteristics such as age, sex distribution, concomittant diseases, bone mineral density (mean T-score values at lumbar spine and femoral neck: -3.29 and -3.25 resp.), and in the number of prevalent vertebral and non-vertebral fractures. During the 3 years of treatment we found a significant increase in lumbar spine density in group A (+2.0%, p < 0.0001), while no significant changes could be documented in group B at both measuring sites. After 3 years 12 new vertebral fractures had occurred in 10 patients of group A and 21 in 17 patients in group B (ns). Correspondingly we registered a significant decrease of back pain only in group A (p < 0.0001). We conclude that alfacalcidol treatment in superior to plain vitamin D in GIOP.
Ringe
J D
JD
Med. Klinik 4, Klinikum Leverkusen.
Cöster
A
A
Meng
T
T
Schacht
E
E
Umbach
R
R
D000328:Adult; D000368:Aged; D015519:Bone Density / Q000187:drug effects; D002118:Calcium / Q000008:administration & dosage* / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D005598:Fractures, Spontaneous / Q000139:chemically induced / Q000188:drug therapy; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D006887:Hydroxycholecalciferols / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced* / Q000188:drug therapy; D011446:Prospective Studies; D016103:Spinal Fractures / Q000139:chemically induced / Q000188:drug therapy; D016896:Treatment Outcome; D014807:Vitamin D / Q000008:administration & dosage* / Q000009:adverse effects
D005938:Glucocorticoids; D006887:Hydroxycholecalciferols; D014807:Vitamin D; D002118:Calcium; C008088:alfacalcidol