Modern Rheumatology

, Volume 18, Issue 3, pp 271–276 | Cite as

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

Original Article

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.

Keywords

Glucocorticoid Osteoporosis Alendronate Alfacalcidol Bone mineral density 

References

  1. 1.
    Cohen D, Adachi JD. The treatment of glucocorticoid-induced osteoporosis. J Steroid Biochem Mol Biol. 2004;88:337–49.PubMedCrossRefGoogle Scholar
  2. 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. 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.PubMedCrossRefGoogle Scholar
  4. 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.PubMedCrossRefGoogle Scholar
  5. 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. 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. 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.Google Scholar
  8. 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.PubMedCrossRefGoogle Scholar
  9. 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.PubMedCrossRefGoogle Scholar
  10. 10.
    Tanaka Y, Okada Y, Nakamura T. Inter- and intracellular signaling in secondary osteoporosis. J Bone Miner Metab. 2003;21:61–6.PubMedCrossRefGoogle Scholar
  11. 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.PubMedCrossRefGoogle Scholar
  12. 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.PubMedCrossRefGoogle Scholar
  13. 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.PubMedCrossRefGoogle Scholar
  14. 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.PubMedCrossRefGoogle Scholar
  15. 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.PubMedCrossRefGoogle Scholar
  16. 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.PubMedCrossRefGoogle Scholar
  17. 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.PubMedGoogle Scholar
  18. 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.CrossRefGoogle Scholar
  19. 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.PubMedCrossRefGoogle Scholar
  20. 20.
    van Staa TP, Leufkens HGM, Cooper C. The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis. Osteoporos Int. 2002;13:777–87.PubMedCrossRefGoogle Scholar
  21. 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.PubMedGoogle Scholar
  22. 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.CrossRefGoogle Scholar
  23. 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.CrossRefGoogle Scholar
  24. 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.PubMedCrossRefGoogle Scholar
  25. 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.PubMedCrossRefGoogle Scholar
  26. 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.PubMedCrossRefGoogle Scholar

Copyright information

© Japan College of Rheumatology 2008

Authors and Affiliations

  1. 1.Division of Nephrology and Rheumatology, Department of Internal MedicineFukuoka University School of MedicineFukuokaJapan
  2. 2.Hakusuien Kasuga HospitalFukuokaJapan

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