Clinical Rheumatology

, Volume 8, Issue 2, pp 202–207

Prevention of glucocorticoid-induced osteopenia: Effect of oral 25-hydroxyvitamin D and calcium

  • O. Di Munno
  • F. Beghe
  • P. Favini
  • P. Di Giuseppe
  • A. Pontrandolfo
  • G. Occhipinti
  • G. Pasero
Originals

Summary

Twenty-four patients (9 M and 15 F, age range 51–82) with polymyalgia rheumatica receiving 6-methylprednisolone for a period of 9 months (16 mg/daily/two weeks, 14 mg/daily/two weeks, 12 mg/daily/1 month, 10 mg/daily/1 month, 8 mg/daily/1 month, 6 mg/daily/1 month and 4 mg/daily for the last four months) were randomly assigned to receive either 250HD3 (35 mcg/day for 25 days/month) (Group A) or placebo (Group B) in a double-blind study. All patients also received 500 mg elemental calcium daily. Before and at 3,6 and 9 months ESR, tenderness on palpation and subjective pain were evaluated. At the same times, mineral metabolism parameters (serum calcium, phosphorus, alkaline phosphatase, 24-h urinary calcium, phosphate and 24-h hydroxyproline excretion) and radial bone mineral content (BMC) were evaluated. Activity indexes (ESR and clinical parameters) improved in both groups. Furthermore, serum alkaline phosphatase and 24-h hydroxyproline excretion decreased significantly only in Group A, and BMC decreased significantly in Group B but rose slightly in Group A. No side effects were observed in any of the patients.

Key words

Polymyalgia Rheumatica Glucocorticoid Osteopenia 25-Hydroxyvitamin D Calcium 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Hahn, T.J., Halstead, L.R., Teitelbaum, S.L., Hahn, B.H. Altered mineral metabolism in glucocorticoid-induced osteopenia. J Clin Invest 1979, 64, 655–665.PubMedGoogle Scholar
  2. 2.
    Hahn, T.J., Hahn, B.H. Osteopenia in patients with rheumatic diseases: principles of diagnosis and therapy. Semin Arthritis Rheum 1976, 6, 165–188.PubMedGoogle Scholar
  3. 3.
    Wajchenberg, B.L., Periera, V.G., Kieffer, J., Ursic, S. Effect of dexamethasone on calcium metabolism and 47Ca kinetics in normal subjects. Acta Endocrinol 1969, 61, 173–192.PubMedGoogle Scholar
  4. 4.
    Fuck, R.F., Kukreja, S.C., Hargis, G.K., Bowser, E.N., Henderson, W.J., Williams, G.D. Effect of glucocorticoids on function of parathyroid glands in man. J Clin Endocrinol Metab 1975, 40, 152–155.PubMedGoogle Scholar
  5. 5.
    Klein, R.G., Arnaud, S.B., Gallagher, J.C., De Luca, H.F., Riggs, B.L. Intestinal calcium absorption in exogenous hypercorticolism. Role of 25-hydroxyvitamin D and corticosteroid dose. J Clin Invest 1977, 60, 253–259.PubMedGoogle Scholar
  6. 6.
    Avioli, L.V., Birge, S.J., Lee, S.W. Effects of prednisone on vitamin D metabolism in man. J Clin Endocrinol Metab 1968, 28, 1341–1346.PubMedGoogle Scholar
  7. 7.
    Carre, M., Ajigebe, O., Miravet, L., Rasmussen, H. The effect of prednisolone upon the metabolism and action of 25-hydroxy and 1,25-dihydroxyvitamin D3. Proc Natl Acad Sci USA 1974, 71, 2996–3000.PubMedGoogle Scholar
  8. 8.
    Brancaccio, D., Coen, G., Galmozzi, C., Casati, S., Rurale, D., Graziani, G., Aroldi, A., Mazzaferro, S., Taccone Gallucci, M., Casciani, C.V. 25-Hydroxycholecalciferol (25-OHD3) plasma levels in anephric patients after oral loading of vitamin D. Mineral Metab Res in Italy 1980, 1 (1), 111–114.Google Scholar
  9. 9.
    Rasmussen, H., Bordier, P. Vitamin D and bone. Metab Bone Dis Rel Res 1978, 1, 7–13.Google Scholar
  10. 10.
    Jowsey, J., Riggs, B.L. Bone formation in hypercorticolism. Acta Endocrinol 1970, 63, 21–28.PubMedGoogle Scholar
  11. 11.
    Bressot, C., Meunier, P.J., Chapuy, M.C., Lejeune, E., Edouard, C., Darby, A.J. Histomorphometric profile, pathophysiology and reversibility of corticosteroid-induced osteoporosis. Metab Bone Dis Rel Res 1979, 1, 303–311.Google Scholar
  12. 12.
    De Luca, H.F. Recent advances in our understanding of the vitamin D endocrine system. J Lab Clin Med 1976, 87, 7–26.PubMedGoogle Scholar
  13. 13.
    Jee, W.SS., Clark, I. Glucocorticoid-induces osteoporosis. In: Recent Advances in Pathogenesis and Treatment, Eds: Baltimore, University Park Press, 1981, 331–342.Google Scholar
  14. 14.
    Aloja, J.F., Roginsky, M., Ellis, K., Shukla, K., Cohn, S. Skeletal metabolism and body composition in Cushing's syndrome. J Clin Endocrinol Metab 1974, 39, 981–985.PubMedGoogle Scholar
  15. 15.
    Bird, H.A., Essenlinck, W., Dixon, A.S., Mowat, A.G., Wood, P.H. An evaluation of criteria for polymyalgia rheumatica. Ann Rheum Dis 1979, 38, 434–439.PubMedGoogle Scholar
  16. 16.
    Kyle, V., Hazleman, B.L. Polymyalgia rheumatica/giant cell arteritis. Clin Exp Rheum 1983, 1, 171–182.Google Scholar
  17. 17.
    Jones, J.G., Hazleman, B.L. Prognosis and management of polymyalgia rheumatica. Ann Rheum Dis 1981, 1, 1–5.Google Scholar
  18. 18.
    Caniggia, A., Nuti, R., Loré, F., Vattimo, A. Pathophysiology of the adverse effects of glucoactive corticosteroids on calcium metabolism in man. J Steroid Biochem 1981, 15, 153–161.PubMedGoogle Scholar
  19. 19.
    Raisz, L.G. Effect of corticosteroids on calcium metabolism. Prog Biochem Pharmacol 1980, 17, 212–219.PubMedGoogle Scholar
  20. 20.
    Dykman, T.R., Haralson, K.M., Gluck, O.S., Murphy, W.A., Teitelbaum, S.L., Hahn, T.J., Hahn, B.H. Effect of oral 1,25-dihydroxyvitamin D and calcium on glucocorticoid-induced osteopenia in patients with rheumatic diseases. Arthritis Rheum 1984, 12, 1336–1343.Google Scholar
  21. 21.
    Davies, M., Mawer, E.B., Adams, P.H. Vitamin D metabolism and the response to 1,25-dihydroxycholecalciferol in osteoporosis. J Clin Endocrinol Metab 1977, 45, 199–208.PubMedGoogle Scholar
  22. 22.
    Siame, J.L., Sebert, J.L., Delcambre, B. L'ostéoporose cortisonique. Nouv Presse Méd 1979, 8/20, 1675–1680.Google Scholar
  23. 23.
    Garabedian, M., Lieberherr, M., N'Guyen, T.M., Corvol, M.T., DuBois, M.B., Balsan, S. The “in vitro” production and activity of 24,25-dihydroxycholecalciferol in cartilage and calvarium. Clin Orthop 1978, 135, 241–248.PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1989

Authors and Affiliations

  • O. Di Munno
    • 1
  • F. Beghe
    • 1
  • P. Favini
    • 2
  • P. Di Giuseppe
    • 1
  • A. Pontrandolfo
    • 1
  • G. Occhipinti
    • 1
  • G. Pasero
    • 1
  1. 1.Rheumatic Diseases UnitUniversity of PisaItaly
  2. 2.Medical DepartmentRoussel MaestrettiMilanItaly

Personalised recommendations