 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
15 December 1996 | Volume 125 Issue 12 | Pages 961-968
Background: Therapy with low-dose corticosteroids is commonly used to treat allergic and autoimmune diseases. Long-term use of corticosteroids can lead to loss of bone mineral density and higher risk for vertebral fractures. Calcium and vitamin D3 supplementation is rational therapy for minimizing bone loss, but little evidence for its effectiveness exists.
Objective: To assess 1) the effects of supplemental calcium and vitamin D3 on bone mineral density of patients with rheumatoid arthritis and 2) the relation between the effects of this supplementation and corticosteroid use.
Design: 2-year randomized, double-blind, placebo-controlled trial.
Setting: University outpatient-care facility.
Patients: 96 patients with rheumatoid arthritis, 65 of whom were receiving treatment with corticosteroids (mean dosage, 5.6 mg/d).
Intervention: Calcium carbonate (1000 mg/d) and vitamin D3 (500 IU/d) or placebo.
Measurements: Bone mineral densities of the lumbar spine and femur were determined annually.
Results: Patients receiving prednisone therapy who were given placebo lost bone mineral density in the lumbar spine and trochanter at a rate of 2.0% and 0.9% per year, respectively. Patients receiving prednisone therapy who were given calcium and vitamin D3 gained bone mineral density in the lumbar spine and trochanter at a rate of 0.72% (P = 0.005) and 0.85% (P = 0.024) per year, respectively. In patients receiving prednisone therapy, bone mineral densities of the femoral neck and the Ward triangle did not increase significantly with calcium and vitamin D3. Calcium and vitamin D3 did not improve bone mineral density, at any site in patients who were not receiving corticosteroids.
Conclusion: Calcium and vitamin D3 prevented loss of bone mineral density in the lumbar spine and trochanter in patients with rheumatoid arthritis who were treated with low-dose corticosteroids.
Author and Article Information
From Medical College of Virginia, Richmond, Virginia; and the University of Vermont, College of Medicine, Burlington, Vermont.
ARTICLE
Calcium and Vitamin D3 Supplementation Prevents Bone Loss in the Spine Secondary to Low-Dose Corticosteroids in Patients with Rheumatoid Arthritis
A Randomized, Double-Blind, Placebo-Controlled Trial
Acknowledgments: The authors thank John Orav, PhD, and Bruce Hillner, MD, for their advice and comments; Mary Merchant, RN, for research assistance; and Maia Eckler for secretarial assistance.
Requests for Reprints: Lenore M. Buckley, MD, MPH, Medical College of Virginia, 1200 East Broad Street, PO Box 980102, Richmond, VA 23298-0102.
Current Author Addresses: Dr. Buckley: Medical College of Virginia, 1200 East Broad Street, PO Box 980102, Richmond, VA 23298-0102.
This article has been cited by other articles:
|
|
 |
|
  M Guler-Yuksel, J Bijsterbosch, Y P M Goekoop-Ruiterman, J K de Vries-Bouwstra, H M J Hulsmans, W M de Beus, K H Han, F C Breedveld, B A C Dijkmans, C F Allaart, et al. Changes in bone mineral density in patients with recent onset, active rheumatoid arthritis Ann Rheum Dis, June 1, 2008; 67(6): 823 - 828. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Fujii, T. Hamano, S. Mikami, Y. Nagasawa, Y. Isaka, T. Moriyama, M. Horio, E. Imai, M. Hori, and T. Ito Risedronate, an effective treatment for glucocorticoid-induced bone loss in CKD patients with or without concomitant active vitamin D (PRIUS-CKD) Nephrol. Dial. Transplant., June 1, 2007; 22(6): 1601 - 1607. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Gulati, R. K. Sharma, K. Gulati, U. Singh, and A. Srivastava Longitudinal follow-up of bone mineral density in children with nephrotic syndrome and the role of calcium and vitamin D supplements Nephrol. Dial. Transplant., August 1, 2005; 20(8): 1598 - 1603. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P N Sambrook How to prevent steroid induced osteoporosis Ann Rheum Dis, February 1, 2005; 64(2): 176 - 178. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. T Cantorna, Y. Zhu, M. Froicu, and A. Wittke Vitamin D status, 1,25-dihydroxyvitamin D3, and the immune system Am. J. Clinical Nutrition, December 1, 2004; 80(6): 1717S - 1720S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. T. Cantorna and B. D. Mahon Mounting Evidence for Vitamin D as an Environmental Factor Affecting Autoimmune Disease Prevalence Experimental Biology and Medicine, December 1, 2004; 229(11): 1136 - 1142. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. A. Adler and M. C. Hochberg Suggested Guidelines for Evaluation and Treatment of Glucocorticoid-Induced Osteoporosis for the Department of Veterans Affairs Arch Intern Med, November 24, 2003; 163(21): 2619 - 2624. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. M. Jehle Steroid-induced osteoporosis: how can it be avoided? Nephrol. Dial. Transplant., May 1, 2003; 18(5): 861 - 864. [Full Text] [PDF]
|
|
|
|
 |
|
 S. S. Yeap and D. J. Hosking Management of corticosteroid-induced osteoporosis Rheumatology, October 1, 2002; 41(10): 1088 - 1094. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Heer, C. Mika, I. Grzella, C. Drummer, and B. Herpertz-Dahlmann Changes in Bone Turnover in Patients with Anorexia Nervosa during Eleven Weeks of Inpatient Dietary Treatment Clin. Chem., May 1, 2002; 48(5): 754 - 760. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. M. Biskobing COPD and Osteoporosis Chest, February 1, 2002; 121(2): 609 - 620. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. A. Yood, L. R. Harrold, L. Fish, J. Cernieux, S. Emani, E. Conboy, and J. H. Gurwitz Prevention of Glucocorticoid-Induced Osteoporosis: Experience in a Managed Care Setting Arch Intern Med, May 28, 2001; 161(10): 1322 - 1327. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Yosipovitch, T. S. Hoon, and G. C. Leok Suggested Rationale for Prevention and Treatment of Glucocorticoid-Induced Bone Loss in Dermatologic Patients Arch Dermatol, April 1, 2001; 137(4): 477 - 481. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. T. Cantorna, C. Munsick, C. Bemiss, and B. D. Mahon 1,25-Dihydroxycholecalciferol Prevents and Ameliorates Symptoms of Experimental Murine Inflammatory Bowel Disease J. Nutr., November 1, 2000; 130(11): 2648 - 2652. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M E LLOYD, T D SPECTOR, and R HOWARD Osteoporosis in neurological disorders J. Neurol. Neurosurg. Psychiatry, May 1, 2000; 68(5): 543 - 547. [Full Text]
|
|
|
|
 |
|
 R. Wernick and S. M. Campbell Update in Rheumatology Ann Intern Med, January 18, 2000; 132(2): 125 - 133. [Full Text] [PDF]
|
|
|
|
 |
|
 E M Scott, I Gaywood, and B B Scott Guidelines for osteoporosis in coeliac disease and inflammatory bowel disease Gut, January 1, 2000; 46(90001): I1 - 8. [Full Text] [PDF]
|
|
|
|
|
|
A. W. C. Kung, T. M. Chan, C. S. Lau, R. W. S. Wong, and S. S. C. Yeung Osteopenia in young hypogonadal women with systemic lupus erythematosus receiving chronic steroid therapy: a randomized controlled trial comparing calcitriol and hormonal replacement therapy Rheumatology, December 1, 1999; 38(12): 1239 - 1244. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Guardiola, X. Xiol, R. Sallie, J. M. Nolla, D. Roig-Escofet, E. Jaurrieta, and L. Casais Influence of the Vitamin D Receptor Gene Polymorphism on Bone Loss in Men after Liver Transplantation Ann Intern Med, November 16, 1999; 131(10): 752 - 755. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. R. Reid Glucocorticoid Osteoporosis: Reid IR Glucocorticoid osteoporosis J Intensive Care Med 1999, 14231-242 J Intensive Care Med, September 1, 1999; 14(5): 231 - 242. [PDF]
|
|
|
|
 |
|
 M.-F. BEAUCHESNE; and J A HUGHES Effect of inhaled corticosteroid therapy on bone markers and bone density Thorax, September 1, 1999; 54(9): 861a - 861. [Full Text]
|
|
|
|
 |
|
 P. S. Mehler, T. Bravender, A. E. Becker, S. K. Grinspoon, A. Klibanski, and D. B. Herzog Eating Disorders N. Engl. J. Med., August 19, 1999; 341(8): 614 - 616. [Full Text]
|
|
|
|
|
|
J E COMPSTON Management of bone disease in patients on long term glucocorticoid therapy Gut, June 1, 1999; 44(6): 770 - 772. [Full Text] [PDF]
|
|
|
|
 |
|
 L.-P. BOULET, J. MILOT, L. GAGNON, P. E. POUBELLE, and J. BROWN Long-Term Influence of Inhaled Corticosteroids on Bone Metabolism and Density . Are Biological Markers Predictors of Bone Loss? Am. J. Respir. Crit. Care Med., March 1, 1999; 159(3): 838 - 844. [Abstract] [Full Text]
|
|
|
|
|
|
P. Geusens, J. Dequeker, J. Vanhoof, R. Stalmans, S. Boonen, J. Joly, J. Nijs, and J. Raus Cyclical etidronate increases bone density in the spine and hip of postmenopausal women receiving long term corticosteroid treatment. A double blind, randomised placebo controlled study Ann Rheum Dis, December 1, 1998; 57(12): 724 - 727. [Abstract] [Full Text]
|
|
|
|
|
|
K. G. Saag, R. Emkey, T. J. Schnitzer, J. P. Brown, F. Hawkins, S. Goemaere, G. Thamsborg, U. A. Liberman, P. D. Delmas, M.-P. Malice, et al. Alendronate for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis N. Engl. J. Med., July 30, 1998; 339(5): 292 - 299. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. R. Reid Glucocorticoid Effects on Bone J. Clin. Endocrinol. Metab., June 1, 1998; 83(6): 1860 - 1862. [Full Text]
|
|
|
|
|
|
J. W J BIJLSMA Prevention of glucocorticoid induced osteoporosis Ann Rheum Dis, September 1, 1997; 56(9): 507 - 509. [Full Text]
|
|
|
|
|
|
I. R. Reid Preventing Glucocorticoid-Induced Osteoporosis N. Engl. J. Med., August 7, 1997; 337(6): 419 - 421. [Full Text]
|
|
|
|
 |
|
 Calcium May Reverse Corticosteroid-Induced Bone Loss Journal Watch Women's Health, February 1, 1997; 1997(201): 6 - 6. [Full Text]
|
|
|
|
 |
|
 CALCIUM AND VITAMIN D3 FOR STEROID-ASSOCIATED OSTEOPOROSIS Journal Watch (General), December 31, 1996; 1996(1231): 3 - 3. [Full Text]
|
|
Article
