Etidronate prevents high dose glucocorticoid induced bone loss in premenopausal individuals with systemic autoimmune diseases.
OBJECTIVE
To assess the efficacy of etidronate and alfacalcidol in preventing glucocorticoid induced bone loss in premenopausal women and men starting high dose glucocorticoid therapy.


METHODS
Premenopausal women (n = 16) and men (n = 5) who had just developed autoimmune diseases, and who agreed to use high dose glucocorticoid therapy for the first time, were randomized to receive alfacalcidol (1 micro g/day) alone (alfacalcidol group, n = 11); or alfacalcidol (1 micro g/day) and intermittent cyclical etidronate (200 mg/day for 14 days), given for 4 cycles (combined group, n = 10). They were treated with these medications as well as high dose glucocorticoids for 12 months.


RESULTS
In the alfacalcidol group the percentage changes in bone mineral density (BMD) of the lumbar spine after 6 and 12 mo of therapy were -9.6 +/- 0.6% and -10.3 +/- 1.0%, respectively. However, in the combined group the percentage changes in lumbar spine BMD after 6 and 12 mo were -3.8 +/- 1.3% and -4.5 +/- 2.1%. The percentage lumbar spine bone loss rate in the combined group was significantly lower than in the alfacalcidol group at both 6 and 12 mo. After 12 mo the percentage change in femoral neck BMD was increased 2.3 +/- 1.5% in the combined group and was decreased 2.5 +/- 2.4% in the alfacalcidol group; this difference was also statistically significant. There were no significant differences in metabolic bone markers between the groups during the study.


CONCLUSIONS
The results suggest that etidronate could prevent high dose glucocorticoid induced bone loss in premenopausal individuals with systemic autoimmune diseases.
Nakayamada
Shingo
S
First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
Okada
Yosuke
Y
Saito
Kazuyoshi
K
Tanaka
Yoshiya
Y
D000276:Adjuvants, Immunologic / Q000008:administration & dosage*; D000328:Adult; D001327:Autoimmune Diseases / Q000150:complications / Q000188:drug therapy*; D015519:Bone Density / Q000187:drug effects; D001862:Bone Resorption / Q000139:chemically induced / Q000188:drug therapy / Q000517:prevention & control*; D004359:Drug Therapy, Combination; D012968:Etidronic Acid / Q000008:administration & dosage*; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D006887:Hydroxycholecalciferols / Q000008:administration & dosage*; D008297:Male; D017697:Premenopause
D000276:Adjuvants, Immunologic; D005938:Glucocorticoids; D006887:Hydroxycholecalciferols; D012968:Etidronic Acid; C008088:alfacalcidol