Prevention and treatment of glucocorticoid-induced osteoporosis: A comparison of calcitriol, vitamin D plus calcium, and alendronate plus calcium

Sambrook, Philip N., Kotowicz, Mark, Nash, Peter, Styles, Colin B., Naganathan, Vasi, Henderson-Briffa, Kathy N., Eisman, John A. and Nicholson, Geoff C. (2003) Prevention and treatment of glucocorticoid-induced osteoporosis: A comparison of calcitriol, vitamin D plus calcium, and alendronate plus calcium. Journal of Bone and Mineral Research, 18 5: 919-924. doi:10.1359/jbmr.2003.18.5.919


Author Sambrook, Philip N.
Kotowicz, Mark
Nash, Peter
Styles, Colin B.
Naganathan, Vasi
Henderson-Briffa, Kathy N.
Eisman, John A.
Nicholson, Geoff C.
Title Prevention and treatment of glucocorticoid-induced osteoporosis: A comparison of calcitriol, vitamin D plus calcium, and alendronate plus calcium
Journal name Journal of Bone and Mineral Research   Check publisher's open access policy
ISSN 0884-0431
1523-4681
Publication date 2003-05-01
Year available 2003
Sub-type Article (original research)
DOI 10.1359/jbmr.2003.18.5.919
Open Access Status Not yet assessed
Volume 18
Issue 5
Start page 919
End page 924
Total pages 6
Place of publication Malden, MA, United States
Publisher Wiley-Blackwell
Language eng
Abstract High-dose corticosteroids, used for many medical conditions, are associated with rapid bone loss from sites such as the vertebrae, and compression fractures can be observed within months. Recent trials suggest treatment with bisphosphonates or active vitamin D analogs can reduce bone loss and the risk of fracture associated with glucocorticoids, but few studies have directly compared such agents. We conducted a randomized, multicenter, open-label trial to compare the efficacy of alendronate, calcitriol, and simple vitamin D in prevention and treatment of glucocorticoid-induced bone loss. A total of 195 subjects (134 females and 61 males) commencing or already taking glucocorticoids were randomized to one of three groups: calcitriol, 0.5 to 0.75 μg/day; simple vitamin D (ergocalciferol, 30,000 IU weekly) plus calcium carbonate (600 mg daily); or alendronate, 10 mg/day plus calcium carbonate (600 mg daily). Over 2 years, mean lumbar bone mineral density change was +5.9% with alendronate, -0.5% with ergocalciferol, and -0.7% with calcitriol (p < 0.001). At the femoral neck, there was no significant difference in bone mineral density change between the treatments over 2 years: alendronate (+ 0.9%), ergocalciferol (-3.2%), and calcitriol (-2.2%). Lumbar bone loss varied according to whether patients were starting or receiving chronic glucocorticoids, and there was a significant treatment x prior glucocorticoid use interaction effect. Six of 66 calcitriol subjects, 1 of 61 ergocalciferol subjects, and 0 of 64 alendronate subjects sustained new vertebral fractures. These data do not suggest any difference between simple vitamin D and calcitriol but do show that alendronate was superior to either treatment for glucocorticoid induced bone loss.
Keyword Glucocorticoids
Bone density
Osteoporosis
Fractures
Vitamin D
Bisphosphonates
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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