Calcium, vitamin D and etidronate for the prevention and treatment of corticosteroid-induced osteoporosis in patients with rheumatic diseases.
BACKGROUND
Long-term glucocorticoid therapy, a major risk factor for the development of osteoporosis, is often necessary in chronically ill patients. At present there are no generally accepted guidelines for the prevention or treatment of steroid-induced osteoporosis.


METHODS
In an open prospective study we investigated 99 patients with chronic rheumatic diseases receiving > or = 5 mg/day of prednisolone or the equivalent for at least one year. The objective was to identify osteoporosis risk factors in addition to glucocorticoid therapy and to evaluate the efficacy of prevention with calcium/vitamin D (group 1--patients with osteopenia) and treatment with cyclical etidronate (group 2--patients with osteoporosis). Biochemical markers of bone turnover, clinical parameters and bone mineral density (BMD) were measured.


RESULTS
Increasing age and postmenopausal status were associated with more advanced manifestations of steroid-induced osteoporosis (p < 0.05). One year after the start of therapy parameters of bone metabolism increased significantly in group 1, while BMD did not change. In group 2, lumbar spine BMD increased significantly (p < 0.05) whereas femoral neck BMD and bone metabolism parameters remained constant. The intensity of back pain decreased in both groups (p < 0.05). There were fewer new fractures in group 2 than in group 1.


CONCLUSIONS
Treatment with etidronate is effective in patients with glucocorticoid-induced osteoporosis.
Loddenkemper
K
K
Department of Rheumatology and Clinical Immunology, Charité University Hospital, Humboldt University of Berlin, Berlin, Germany. konstanze.loddenkemper@charite.de
Grauer
A
A
Burmester
G R
GR
Buttgereit
F
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000188:drug therapy / Q000503:physiopathology / Q000517:prevention & control; D015519:Bone Density / Q000187:drug effects; D002118:Calcium / Q000627:therapeutic use*; D012968:Etidronic Acid / Q000627:therapeutic use*; D005260:Female; D005272:Femur Neck / Q000187:drug effects / Q000378:metabolism; D005598:Fractures, Spontaneous / Q000517:prevention & control; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D008159:Lumbar Vertebrae / Q000187:drug effects / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced* / Q000188:drug therapy* / Q000517:prevention & control; D011239:Prednisolone / Q000009:adverse effects*; D011446:Prospective Studies; D012216:Rheumatic Diseases / Q000188:drug therapy*; D016896:Treatment Outcome; D014807:Vitamin D / Q000627:therapeutic use*
D005938:Glucocorticoids; D014807:Vitamin D; D011239:Prednisolone; D012968:Etidronic Acid; D002118:Calcium