Summary
Long-term glucocorticoid treatment might interfere with the vitamin D metabolism. The serum concentrations of 25-OHD were significantly reduced whereas the circulating levels of 1,25-(OH)2D were normal in 50 patients with rheumatoid arthritis on long-term treatment with small doses of prednisone. The bone mineral content of the forearm was significantly reduced, but the degree of bone loss did not correlate with duration of treatment or dose of prednisone given. Quantitative bone histomorphometry was performed in 18 patients. Apart from a significant correlation between serum 25-OHD and the fractional trabecular bone volume, no relationships were observed between bone histomorphometry and vitamin D metabolites or serum iPTH. The results indicate that the bone loss was due to a decreased osteoblastic activity rather than to an impaired vitamin D metabolism.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Favus, M.J., Kimberg, D.V., Millar, G.N., Gershon, E. Effects of cortisone administration on the metabolism and localization of 25-hydroxychole-calciferol in the rat. J Clin Invest, 1973. 52, 1328–1335.
Carré, M., Ayigbedé, O. Miravet, L., Rasmussen, H. The effect of prednisolone® upon the metabolism and action of 25-hydroxy- and 1,25 dihydroxy-vitamin D3. Proc Nat Acad Sci USA, 1974, 71, 2996–3000.
Lukert, B.P., Stanbury, S.W., Mawer, E.B. Vitamin D and intestinal transport of calcium: effects of prednisolone. Endocrinology, 1973, 93, 718–722.
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.
Bressot, C., Meunier, P.J., Chapuy, M.C., Leujeune, E., Edouard, C., Darby, A.J. Histomorphometric profile, pathophysiology and reversibility of corticosteroid-induced osteoporosis. Metab Bone Dis Relat Res, 1979, 1, 303–311.
Klein, R.G., Arnaud, S.B., Gallagher, J.C., DeLuca, H.F., Riggs, B.L. Intestinal calcium absorption in exogenous hypercortisonism. Role of 25-hydroxyvitamin D and corticosteroid dose. J Clin Invest, 1977, 60, 253–259.
Seeman, E., Kumar, R., Hunder, G.G., Scott, M., Heath, H., Riggs, B.L. Production, degradation, and circulating levels of 1,25-dihydroxyvitamin D in health and in chronic glucocorticoid excess. J Clin Invest, 1980, 66, 664–669.
Hahn, T.J., Halstead, L.R., Haddad, J.G. Serum 25-hydroxyvitamin D concentrations in patients receiving chronic corticosteroid therapy. J Lab Clin Med, 1977, 90, 399–404.
Slovik, D.M., Neer, R.M., Ohman, J.L., Lowell, F.C., Clark, M.B., Segre, G.V., Potts, J.T. Parathyroid hormone and 25-hydroxyvitamin D levels in glucocorticoid-treated patients. Clin Endocrinol 1980, 12, 243–248.
Hahn, T.J., Halstead, L.R., Baran, D.T. Effects of short term glucocorticoid administration on intestinal calcium absorption and circulating vitamin D metabolite concentrations in man. J Clin Endocrinol Metab, 1981, 52, 111–115.
Chesney, R.W., Hamstra, A.J., Mazess, R.B., DeLuca, H.F., O'Reagan, S. Reduction of serum 1,25-dihydroxyvitamin D3 in children receiving glucocorticoids. Lancet, 1978, 2, 1123–1125.
O'Regan, S., Chesney, R.W., Hamstra, A., Eisman, J.A., O'Gorman, A.M., DeLuca, H.F. Reduced serum 1,25-(OH)2 vitamin D3 levels in prednisone-treated adolescents with systemic lupus erythematosus. Acta Paediatr Scand, 1979, 68, 109–111.
Gallagher, J.C., Aaron, J., Horsman, A., Wilkinson, R., Nordin, B.E.C. Corticosteroid osteoporosis. Clin Endocrinol Metab, 1973, 2, 355–368.
Hahn, T.J., Halstead, L.R., Teitelbaum, S.L., Hahn, B.H. Altered mineral metabolism in glucocorticoid-induced osteopenia. Effect of 25-hydroxyvitamin D administration. J Clin Invest, 1979, 64, 655–665.
Lund, B., Sørensen, O.H. Measurements of 25-hydroxyvitamin D in serum and its relation to sunshine, age and vitamin D intake in the Danish population. Scand J Clin Lab Invest, 1979, 39, 23–30.
Lund, B., Lund, B., Sørensen, O.H. Measurement of circulating, 1,25-dihydroxyvitamin D in man. Changes in serum concentrations during treatment with 1α-hydroxycholecalciferol. Acta Endocrinol, (Copenh), 1979, 91, 338–350.
Fisher, J.A., Binswanger, U., Dietrich, F.C. Human parathyroid hormone. Immunological characterization of antibodies against a glandular extract and the synthetic amino-terminal fragments 1–12 and 1–34 and their use in the determination of immunoreactive hormone in human sera. J Clin Invest, 1974, 54, 1382–1394.
Cameron, J.R., Sorensen, J. Measurement of bone mineral in vivo: An improved method. Science, 1963, 142, 230–232.
Melsen, F., Mosekilde, L. Tetracycline double-labeling of iliac trabecular bone in 41 normal adults. Calcif Tiss Res, 1978, 26, 99–102.
Reid, D.M., Kennedy, N.S.J., Smith, M.A., Tothill, P., Nuki, G. Total body calcium in rheumatoid arthritis: effects of disease activity and corticoid treatment. Br Med J, 1982, 285, 330–332.
Frost, H.M., Villanueva, A.R. Human osteoblastic activity — Part III. The effect of cortisone on lamellar osteoblastic activity. Henry Ford Hosp Med Bull J, 1961, 97–99.
Peck, W.A., Brandt, J., Miller, I. Hydrocortisone-induced inhibition of protein synthesis and uridine incorporation in isolated bone cells in vitro. Proc Natl Acad Sci USA, 1967, 57, 1599–1606.
Thompson, J.S., Palmieri, G.M.A., Crawford, R.L. The effect of porcine calcitonin on osteoporosis induced by adrenal cortical steroids. J Bone Joint Surg, 1972, 54A. 1490–1496.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Lund, B., Storm, T.L., Lund, B. et al. Bone mineral loss, bone histomorphometry and vitamin D metabolism in patients with rheumatoid arthritis on long-term glucocorticoid treatment. Clin Rheumatol 4, 143–149 (1985). https://doi.org/10.1007/BF02032284
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02032284