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Effect of alendronate on glucocorticoid-induced osteoporosis in Japanese women with systemic autoimmune diseases: versus alfacalcidol

  • Original Article
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Modern Rheumatology

Abstract

Glucocorticoids-induced osteoporosis is a serious problem for patients with systemic autoimmune disease requiring relatively long-term glucocorticoid treatment. Effectiveness of alendronate for the prevention of glucocorticoids-induced osteoporosis was evaluated in comparison with that of alfacalcidol in Japanese women with autoimmune disease excluding rheumatoid arthritis. Loss of bone mass was evaluated with bone mineral density (BMD) of lumber vertebrae, bone resorption was with urinary N-telopeptide for type I collagen (NTX), and bone formation was with serum bone-specific alkaline phosphatase (B-ALP). A total of 33 patients who were treated with oral glucocorticoids (≥5 mg/day of prednisolone equivalence) for more than 6 months were randomized into two groups; alendronate group (n = 17) received 5 mg/day of alendronate, and alfacalcidol group (n = 16) received 1.0 μg/day of alfacalcidol for 24 months with glucocorticoids. The dose of alendronate was the maximal dose approved in Japan. BMD had tendency to decrease with alfacalcidol, while increase with alendronate. The difference in BMD change between the two groups was significant by 4.3% at 18 months and by 4.2% at 24 months (both P < 0.05). Bone resorption was significantly reduced only with alendronate; NTX was decreased by 28 to 35% at 6 to 24 months (P < 0.05), but not changed with alfacalcidol at 24 months. The bone formation was found to be unchanged according to the B-ALP measured between the two groups. In conclusion, the treatment of 5 mg alendronate daily is more effective than alfacalcidol for preventing the glucocorticoid-induced osteoporosis by the mechanism of reducing bone resorption in Japanese women with systemic autoimmune disease.

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References

  1. Cohen D, Adachi JD. The treatment of glucocorticoid-induced osteoporosis. J Steroid Biochem Mol Biol. 2004;88:337–49.

    Article  PubMed  CAS  Google Scholar 

  2. American College of Rheumatology Task Force on osteoporosis guidelines recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Rheum. 1996;39:1797–801.

    Google Scholar 

  3. Eastell R, Reid DM, Compston J, Cooper C, Fogelman I, Francis RM, Hosking DJ, Purdie DW, et al. A UK consensus group on management of glucocorticoid-induced osteoporosis: an update. J Intern Med. 1998;244:271–92.

    Article  PubMed  CAS  Google Scholar 

  4. Adachi JD, Olszynski WP, Hanley DA, Hodsman AB, Kendler DL, Siminoski KG, et al. Management of corticosteroid-induced osteoporosis. Semin Arthritis Rheum. 2000;29:228–52.

    Article  PubMed  CAS  Google Scholar 

  5. American College of Rheumatology ad hoc committee on glucocorticoid-induced osteoporosis recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Update. Arthritis Rheum. 2001;44:1496–503.

    Google Scholar 

  6. Brown JP, Josse RG. Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. Can Med Assoc J. 2002;167:1S–34S.

    Google Scholar 

  7. Bone and Tooth Society, National Osteoporosis Society, Royal College of Physicians Glucocorticoid-induced osteoporosis: guidelines for prevention and treatment. Royal College of Physicians, London 2002.

  8. Wasnich RD, Miller PD. Antifracture efficacy of antiresorptive agents are related to changes in bone density. J Clin Endocrinol Metab. 2000;85:231–6.

    Article  PubMed  CAS  Google Scholar 

  9. Nawata H, Soen S, Takayanagi R, Tanaka I, Takaoka K, Fukunaga M, et al. Guidelines on the management and treatment of glucocorticoid-induced osteoporosis of the Japanese Society for Bone and Mineral Research (2004). J Bone Miner Metab. 2005;23:105–9.

    Article  PubMed  Google Scholar 

  10. Tanaka Y, Okada Y, Nakamura T. Inter- and intracellular signaling in secondary osteoporosis. J Bone Miner Metab. 2003;21:61–6.

    Article  PubMed  Google Scholar 

  11. Barrett-Connor E, Siris ES, Wehren LE, Miller PD, Abbott TA, Berger ML, Santora AC, Sherwood LM. Osteoporosis and fracture risk n female patients of different ethnic groups. J Bone Miner Res. 2005;20:185–94.

    Article  PubMed  Google Scholar 

  12. Saag KG, Emkey R, Schnitzer TJ, Brown JP, Hawkins F, Goemaere S, et al. Alendronate for the prevention and treatment of glucocorticoid-induced osteoporosis. Glucocorticoid-induced osteoporosis intervention study group. N Engl J Med. 1998;339:292–9.

    Article  PubMed  CAS  Google Scholar 

  13. Reginster JY, Kuntz D, Verdickt W, Wouters M, Guillevin L, Menkes CJ, et al. Prophylactic use of alfacalcidol in corticosteroid-induced osteoporosis. Osteoporos Int. 1999;9(1):75–81.

    Article  PubMed  CAS  Google Scholar 

  14. Adachi JD, Saag KG, Delmas PD, Liberman UA, Emkey RD, Seeman E, et al. Two-year effects of alendronate on bone mineral density and vertebral fracture in patients receiving glucocorticoids: a randomized, double-blind, placebo-controlled extension trial. Arthritis Rheum. 2001;44(1):202–11.

    Article  PubMed  CAS  Google Scholar 

  15. de Nijs RNJ, Jacobs JWG, Lems WF, Laan RFJ, Algra A, Huisman AM, et al. Alendronate or alfacalcidol in glucocorticoid-induced osteoporosis. N Engl J Med. 2006;355:675–84.

    Article  PubMed  Google Scholar 

  16. Dykman TR, Gluck OS, Murphy WA, Hahn TJ, Hahn BH. Evaluation of factors associated with glucocorticoid-induced osteopenia in patients with rheumatic diseases. Arthritis Rheum. 1985;28:361–8.

    Article  PubMed  CAS  Google Scholar 

  17. McEvoy CE, Ensrud KE, Bender E, Genant HK, Yu W, Griffith JM, et al. Association between corticosteroid use and vertebral fractures in older men with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1998;157:704–9.

    PubMed  CAS  Google Scholar 

  18. van Staa TP, Leufkens HGM, Abenhaim L, Zhang B, Cooper C. Oral corticosteroids and fracture risk: relationship to daily and cumulative doses. Rheumatol. 2000;39:1383–9.

    Article  Google Scholar 

  19. Walsh LJ, Wong CA, Oborne J, Cooper S, Lewis SA, Pringle M, et al. Adverse effects of oral corticosteroids in relation to dose in patients with lung disease. Thorax. 2001;56:279–84.

    Article  PubMed  CAS  Google Scholar 

  20. van Staa TP, Leufkens HGM, Cooper C. The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis. Osteoporos Int. 2002;13:777–87.

    Article  PubMed  Google Scholar 

  21. McKenzie R, Reynolds JC, O’Fallon A, Dale J, Deloria M, Blackwelder W, Straus S. Decreased bone mineral density during low dose glucocorticoid administration in a randomized, placebo controlled trial. J Rheumatol. 2000;27:2222–6.

    PubMed  CAS  Google Scholar 

  22. Shiraki M, Kushida K, Fukunaga M, Kishimoto H, Kaneda K, Minaguchi H, et al. A placebo-controlled, single-blinded study to determine the appropriate alendronate dosage in postmenopausal Japanese patients with osteoporosis. Endocrine J. 1998;45(2):191–201.

    Article  CAS  Google Scholar 

  23. Shiraki M, Kushida K, Fukunaga M, Kishimoto H, Taga M, Nakamura T, et al. A double-masked multicenter comparative study between alendronate and alfacalcidol in Japanese patients with osteoporosis. Osteoporosis Int. 1999;10:183–92.

    Article  CAS  Google Scholar 

  24. Kushida K, Shiraki M, Nakamura T, Kishimoto H, Morii H, Yamamoto K, et al. Alendronate reduced vertebral fracture risk in postmenopausal Japanese female patients with osteoporosis: a 3-year follow-up study. J Bone Miner Metab. 2004;22:462–8.

    Article  PubMed  CAS  Google Scholar 

  25. Balena R, Toolan BC, Shea M, Markatos A, Myers ER, Lee SC, et al. The effects of 2-year treatment with the aminobisphosphonate alendronate on bone metabolism, bone histomorphometry, and bone strength in ovariectomized nonhuman primates. J Clin Invest. 1993;92:2577–86.

    Article  PubMed  CAS  Google Scholar 

  26. Ravn P, Thompson DE, Ross PD, Christiansen C. Biochemical markers for prediction of 4-year response in bone mass during bisphosphonate treatment for prevention of postmenopausal osteoporosis. Bone. 2003;33:150–8.

    Article  PubMed  CAS  Google Scholar 

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Conflict of interest

The authors of the present study have no financial conflict of interests.

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Authors and Affiliations

  1. Division of Nephrology and Rheumatology, Department of Internal Medicine, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan

    Seiji Takeda, Hidetoshi Kaneoka & Takao Saito

  2. Hakusuien Kasuga Hospital, 1105 Imajyukuaoki, Nishi-ku, Fukuoka, 819-0162, Japan

    Seiji Takeda

Authors
  1. Seiji Takeda
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  2. Hidetoshi Kaneoka
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  3. Takao Saito
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Correspondence to Seiji Takeda.

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Takeda, S., Kaneoka, H. & Saito, T. Effect of alendronate on glucocorticoid-induced osteoporosis in Japanese women with systemic autoimmune diseases: versus alfacalcidol. Mod Rheumatol 18, 271–276 (2008). https://doi.org/10.1007/s10165-008-0055-y

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  • DOI: https://doi.org/10.1007/s10165-008-0055-y

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