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Update in Endocrinology
- Janet A. Schlechte, MD; and
- Robert Kreisberg, MD
- 1998-99 Series: John Roberts, MD, Editor From University of Iowa, Iowa City, Iowa; and Baptist Health Center, Birmingham, Alabama. Requests for Reprints: Janet A. Schlechte, MD, University of Iowa Clinical Research Center, Room 157 MRF, 200 Hawkins Drive, Iowa City, IA 52242. Current Author Addresses: Dr. Schlechte: University of Iowa Clinical Research Center, Room 157 MRF, 200 Hawkins Drive, Iowa City, IA 52242.
Important advances in endocrinology that were reported during the past year focused on five major areas: osteoporosis and calcium, diagnostic testing and treatment of thyroid disease, prolactinomas, groups that may benefit from lipid-lowering drugs, and a redefinition of diabetes mellitus.
Osteoporosis and Calcium
A bisphosphonate drug was shown to help prevent fractures in some persons taking high-dose prednisone for at least 1 year. A selective estrogen receptor modulator, raloxifene, was shown to favorably alter several markers of complications of the postmenopausal state without increasing the risk for breast cancer. Finally, the incidence of primary hyperparathyroidism has decreased dramatically since 1975, although the reasons for this decline are unclear.
Etidronate Reduced Fractures in Patients Taking Prednisone
Adachi JD, Bensen WG, Brown J, et al. Intermittent etidronate therapy to prevent corticosteroid-induced osteoporosis. N Engl J Med. 1997; 337:382-7.
Much attention is now being given to the detection and treatment of postmenopausal osteoporosis, but we continue to have difficulty treating glucocorticoid-induced osteoporosis. Glucocorticoids inhibit calcium absorption, but their primary contribution to the treatment of osteoporosis is their ability to decrease bone formation.
Adachi and colleagues used cyclic etidronate therapy to determine whether corticosteroid-induced osteoporosis could be prevented. They conducted a 12-month, randomized, placebo-controlled study in 141 men and women who had recently begun high-dose glucocorticoid therapy and were expected to continue receiving this therapy for at least 1 year. The patients were ambulatory and ranged in age from 19 to 87 years. They had received glucocorticoids for various reasons, primarily rheumatoid arthritis or polymyalgia rheumatica. They were randomly assigned to receive etidronate, 400 mg/d, or placebo for 14 days. This regimen was followed by 76 days of calcium carbonate, 500 mg/d. This cycle was repeated three times. The primary outcome measure was lumbar bone density. Secondary outcome measures included bone density in the femur, trochanter, and radius and the rate of new vertebral …
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