Abstract
Prolonged corticosteroid therapy is known to result in an increased risk of osteoporotic fracture, probably as a consequence of enhanced bone resorption and depressed bone formation. We examined the effects of prophylactic treatment with 1,25-dihydroxyvitamin D3 (calcitonin) and nasal salmon calcitonin on corticosteroid-induced bone loss in 103 patients being treated with long-term corticosteroids for the first time in a randomized, double-masked prospective study. Patients were randomly allocated to one of three groups receiving either calcium supplementation alone, calcium plus calcitriol, or calcium plus calcitriol and nasal salmon calcitonin. Treatment was given for 12 months. Bone mineral density (BMD) was measured every 4 months by dual-photon absorptiometry in the lumbar spine and femoral neck. Calcium supplementation alone did not prevent bone loss at either site. In the lumbar spine calcitriol, with or without nasal calcitonin, significantly reduced bone loss (p<0.0001). Neither calcitriol alone nor calcitriol with calcitonin prevented bone loss at the femoral neck. These data suggest that treatment with calcium and calcitriol, or with calcium and intranasal calcitonin, greatly reduced or prevented corticosteroid-induced bone loss in the lumbar spine.
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References
Baylink DJ. Glucocorticoid-induced osteoporosis. N Engl J Med 1983;309:106–8.
Avioli LV. Effects of chronic corticosteroid therapy on mineral metabolism and calcium absorption. Adv Exp Med Biol 1984;171:81–9.
Seeman E, Wahner HE, Offord KP, Kumar R, Johnson WJ, Riggs BL. Differential effects of endocrine dysfunction on the axial and the appendicular skeleton. J Clin Invest 1982;69:1302–9.
Adinoff AD, Hollister JR. Steroid-induced fractures and bone loss in patients with asthma. N Engl J Med 1983;309:265–8.
Sambrook PN, Kempler S, Birmingham J, Kelly PJ, Pocock NA, Yeates MG, Eisman JA. Corticosteroid effects on proximal femur bone loss. J Bone Miner Res 1990;5:1211–6.
Klein RG, Arnaud SB, Gallagher JC, De Luca HF, Riggs BL. Intestinal calcium absorption in exogenous hypercortisolism: role of 25,dihydroxyvitamin D and corticosteroid dose. J Clin Invest 1977;60:253–9.
Dykman TR, Haralson KM, Gluck OS, Murphy WA, Teitelbaum SL, Hahn TJ, et al. Effect of oral 1,25-dihydroxyvitamin D and calcium on glucocorticoid-induced osteopenia in patients with rheumatic diseases. Arthritis Rheum 1984;27:1336–43.
Ringe JD, Welzel D. Salmon calcitonin in the therapy of corticoid-induced osteoporosis. Eur J Clin Pharmacol 1987;33:35–9.
Rizzato G, Tosi G, Schiraldi G, Montemurro L, Zanni D, Sisti S. Bone protection with salmon calcitonin (sCT) in the long term steroid therapy of chronic sarcoidosis. Sarcoidosis 1988;5:99–103.
Luengo M, Picado C, Del Rio L, Guanabens N, Monsterrat JM, Setoain J. Treatment of steroid-induced osteopenia with calcitonin in corticosteroid-dependent asthma. Am Rev Respir Dis 1990;142:104–7.
Gennari C, Civitelli R. Glucocorticoid-induced osteoporosis. Clin Rheum Dis 1986;12:637–54.
Pocock SJ, Simon R. Sequential treatment assignment with balancing for prognostic factors in the controlled clinical trial. Biometrics 1975;31:103–15.
Pocock NA, Eberl S, Eisman JA, Yeates MG, Sambrook PN, Freund J, Duncan A. Dual photon absorptiometry in normal Australian women: a cross-sectional study. Med J Aust 1987;146:293–7.
Reid IR, Ibbertson HK. Calcium supplements in the prevention of steroid-induced osteoporosis. Am J Clin Nutr 1986;44:287–90.
Reginster JY, Denis D, Albert A, Franchimont P. Assessment of the biological effectiveness of nasal synthetic salmon calcitonin (SSCT) by comparison with intramuscular (im) or placebo injection in normal subjects. Bone Miner 1987;2:133–40.
Overgaard K, Riis BJ, Christiansen C, Hansen MA. Effect of calcitonin intranasally on early postmenopausal bone loss. BMJ 1989;299:477–9.
Riggs BL, Hodgson SF, O'Fallon W, Chao EYS, Wahner HW, Muhs JM, et al. Effect of fluoride treatment on the fracture rate in postmenopausal women with osteoporosis. N Engl J Med 1990;322:802–9.
Watts NB, Harris ST, Genant HK, Wasnich RD, Miller PD, Jackson RD, et al. Intermittent cyclical etidronate treatment of postmenopausal osteoporosis. N Engl J Med 1990;323:73–9.
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Sambrook, P., Birmingham, J., Kelly, P. et al. Prevention of corticosteroid bone loss. Osteoporosis Int 3 (Suppl 1), 141–143 (1993). https://doi.org/10.1007/BF01621889
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DOI: https://doi.org/10.1007/BF01621889