title: Effect of risedronate on high-dose corticosteroid-induced bone loss in patients with glomerular disease.
abstract: BACKGROUND
  Corticosteroids are often used for the treatment of glomerular diseases. We examined whether bisphosphonate or vitamin D3 has beneficial effects on bone mineral density (BMD) in patients with glomerular diseases being treated with high-dose corticosteroids, including pulse therapy.
  
  
  METHODS
  Thirty-eight patients (19 men and 19 women, aged 42 +/- 16 years) were randomized into three groups: bisphosphonate alone (risedronate 2.5 mg/day, group R, n = 12), vitamin D3 alone (alfacalcidol 0.5 mug/day, group A, n = 15) and the combination of both agents (group R+A, n = 11). BMD at the lumbar spine was measured before and 12 months after treatment. The biochemical parameters of bone metabolism were assessed before and 3, 6 and 12 months after treatment.
  
  
  RESULTS
  In group R+A, BMD was significantly increased (+2.0%), whereas BMD was significantly decreased in group A (-5.6%). The BMD in group R did not show a significant change. In patients treated with steroid-pulse, BMD was decreased in groups R and A. In group R+A, BMD was significantly increased (+2.1%). Serum osteocalcin and alkaline phosphatase levels, markers of bone formation, were significantly decreased in all groups. Urinary crosslinked N-telopeptide of type I collagen (NTx) levels, a marker of bone resorption, were decreased in groups R and R+A. In patients with decreased BMD, the urinary NTx levels at baseline were significantly higher than the patients with increased BMD.
  
  
  CONCLUSIONS
  Bisphosphonate might be beneficial for the prevention of steroid-induced bone loss in patients with glomerular diseases compared with vitamin D3. The combined therapy may be more effective, especially in patients treated with high-dose corticosteroids, including pulse therapy. A high urinary NTx level before receiving corticosteroids might be a predictive marker of the loss of BMD.
authors.affiliation: Second Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan. grd1615@ndmc.ac.jp
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Kikuchi
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Imakiire
authors.forename: Muneharu
authors.initials: M
authors.lastname: Yamada
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Saigusa
authors.forename: Toshitake
authors.initials: T
authors.lastname: Hyodo
authors.forename: Taketoshi
authors.initials: T
authors.lastname: Kushiyama
authors.forename: Keishi
authors.initials: K
authors.lastname: Higashi
authors.forename: Naomi
authors.initials: N
authors.lastname: Hyodo
authors.forename: Kojiro
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Shigenobu
authors.initials: S
authors.lastname: Suzuki
authors.forename: Soichiro
authors.initials: S
authors.lastname: Miura
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D050071:Bone Density Conservation Agents / Q000494:pharmacology*; D001851:Bone Diseases, Metabolic / Q000139:chemically induced / Q000188:drug therapy* / Q000473:pathology; D004305:Dose-Response Relationship, Drug; D012968:Etidronic Acid / Q000031:analogs & derivatives* / Q000494:pharmacology; D005260:Female; D005921:Glomerulonephritis / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000009:adverse effects* / Q000494:pharmacology; D011446:Prospective Studies; D000068296:Risedronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D011239:Prednisolone; D000068296:Risedronic Acid; D012968:Etidronic Acid