Osteopenia in patients with glomerular diseases requiring long-term corticosteroid therapy.
BACKGROUND
Chronic corticosteroid (CS) use is associated with bone mass loss.


METHODS
Bone mineral density (BMD) was assessed in 72 patients (25 males/47 premenopausal females) with glomerular diseases, primary (n = 35) or secondary to systemic lupus erythematosus (n = 37) with normal renal function, who were taking CS, as prednisone and/or methylprednisolone, in doses > or =7.5 mg/day, for a period of at least 6 months. Cumulative dose and duration of prior CS therapy, as well as biochemical parameters and other factors contributing to bone loss were evaluated.


RESULTS
We found 37 (52%) patients with LOW BMD (29 with osteopenia and 8 with osteoporosis). The low BMD group presented a lower mean weight and body mass index (BMI) versus the normal BMD group (62 +/- 15 vs. 70 +/- 10 kg and 25 +/- 4 vs. 27 +/- 5, mean +/- SD, p < 0.05). The estimated calcium intake was lower than 400 mg/day in all patients with low BMD, and they had taken furosemide as a concomitant drug for a longer mean period of time when compared to normal BMD patients (30 +/- 29 vs. 16 +/- 27 months, p < 0.05). A higher mean number of pulses per patient and mean cumulative dose of methylprednisolone were observed in the low versus normal BMD group (7.7 +/- 4.0 vs. 5.6 +/- 4.0 pulses and 6.5 +/- 3.9 vs. 3.9 +/- 2.7 g, p < 0.05).


CONCLUSIONS
These findings suggest a high frequency of osteopenia among young and premenopausal patients with glomerular diseases given long-term corticosteroid therapy. The lower BMI and calcium intake, as well as the concomitant furosemide use, might have contributed to such a bone loss. The higher number of pulse therapies leading to higher cumulative intravenous doses of corticosteroid mainly in lupus nephritis patients shows that pulse therapy may be deleterious to bone.
de Deus
Rogério Barbosa
RB
Nephrology Division, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil.
Ferreira
Alessandra Conde
AC
Kirsztajn
Gianna Mastroianni
GM
Heilberg
Ita Pfeferman
IP
D000305:Adrenal Cortex Hormones / Q000009:adverse effects* / Q000627:therapeutic use*; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D015519:Bone Density / Q000187:drug effects; D001851:Bone Diseases, Metabolic / Q000097:blood / Q000139:chemically induced*; D002118:Calcium / Q000097:blood / Q000378:metabolism; D004334:Drug Administration Schedule; D005260:Female; D005272:Femur Neck / Q000737:chemistry / Q000187:drug effects / Q000473:pathology; D006801:Humans; D007262:Infusions, Intravenous; D007674:Kidney Diseases / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D008159:Lumbar Vertebrae / Q000737:chemistry / Q000187:drug effects / Q000473:pathology; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000473:pathology; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D020551:Pulse Therapy, Drug / Q000009:adverse effects / Q000379:methods
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D002118:Calcium; D011241:Prednisone; D008775:Methylprednisolone