Calcium and Vitamin D<sub>3</sub>Supplementation Prevents Bone Loss in the Spine Secondary to Low-Dose Corticosteroids in Patients with Rheumatoid Arthritis

Buckley, Lenore M.; Leib, Edward S.; Cartularo, Kathryn S.; Vacek, Pamela M.; Cooper, Sheldon M.

doi:10.7326/0003-4819-125-12-199612150-00004

Cited by 299 publications

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“…1 These recommendations are based on the safety profile of moderately dosed calcium and vitamin D and studies demonstrating that (1) oral glucocorticoids can lead to rapid bone loss within the first 3 months of glucocorticoid use, 2 and (2) while the risk of GIOP increases with the cumulative glucocorticoid dose, there is no dose of glucocorticoids that does not accelerate bone loss or increase fracture risk; 3,4 (3) several randomized controlled trials have shown that the administration of calcium and vitamin D in patients undergoing glucocorticoid therapy can prevent early bone loss. [5][6][7] In contrast, recommendations regarding the use of bisphosphonates are individualized based on risk factors and childbearing potential.…”

Section: Introductionmentioning

confidence: 99%

Use of a Computerized Order Set to Increase Prescription of Calcium and Vitamin D Supplementation in Patients Receiving Glucocorticoids

et al. 2013

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BACKGROUND: American College of Rheumatology guidelines recommend that patients taking glucocorticoids also take calcium and vitamin D supplements, regardless of the dose or intended duration of glucocorticoid use, to decrease their risk of glucocorticoid-induced osteopenia or osteoporosis (GIOP). OBJECTIVE: To increase the number of prescriptions made for calcium and vitamin D in patients who receive a prescription for glucocorticoids using an automated, computerized order set. DESIGN: Pre-post test design. PATIENTS: A total of 1,041 outpatients receiving care at a single VA medical center. INTERVENTION/MAIN MEASURES:We developed an automated order set in which calcium and vitamin D were automatically co-ordered with glucocorticoid prescriptions of at least 2-week duration. We tested the impact of the order set by comparing the number of calcium and vitamin D prescriptions in patients taking glucocorticoids during a 12-month period before (T1) and after (T2) implementation. The automated order set could be modified by the treating physician, and it was not generated for patients with hypercalcemia. KEY RESULTS: A total of 535 patients during T1 and 506 patients during T2 had a glucocorticoid prescription of at least 2-week duration. The percent of coprescriptions for calcium increased from 37 to 49 % and vitamin D from 38 to 53 % (both p<0.0001) after the new automated order set was implemented. CONCLUSIONS: Implementation of an automatic prescription for calcium and vitamin D supplementation modestly increases the number of patients on glucocorticoids who are prescribed calcium and vitamin D supplementation.

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Section: Introductionmentioning

confidence: 99%

Use of a Computerized Order Set to Increase Prescription of Calcium and Vitamin D Supplementation in Patients Receiving Glucocorticoids

et al. 2013

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“…Calcium and vitamin D supplementation have been shown to ameliorate bone loss 26 and bisphosphonates unarguably reduce bone loss and replenish bone once lost. 5,27 Other drugs such as calcitriol 28 and calcitonin 29 prove beneficial in some circumstances.…”

Section: Discussionmentioning

confidence: 99%

Corticosteroid-induced osteoporosis in patients with uveitis

Jones

Anderton

Whallett

et al. 2002

Eye

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Aims To estimate the prevalence of low bone density and osteoporosis in a population of patients with uveitis taking systemic steroid treatment; to clarify the risks of steroid-induced fracture and to suggest a protocol for the prevention and management of bone loss in patients with ophthalmic inflammatory disease. Methods Bone densitometry was performed on 129 adult patients with prednisolonetreated uveitis from four centres. Information on uveitis diagnosis, associated risk factors, steroid dosage and treatment duration, prophylaxis and management, was collected. Juveniles, patients with scleritis and those who had used deflazacort, were excluded. Results Steroid treatment time varied from 13 weeks to 31 years, and the total dosage from 1.29 g to 166.5 g. Twenty-six percent of patients also used one or more immunosuppressives. Forty-eight percent had additional risk factors for bone loss. Bone density was abnormally low in 44.2%, and 15.5% had osteoporosis. Osteoporosis was substantially more common in males (20.6%, all under 60 yrs) than in females (9.8%). Seven symptomatic fractures occurred in patients on treatment. Bone loss correlated with total steroid dose, mean dose, duration of treatment and the presence of pre-existing risk factors. Conclusions The prevalence of steroidinduced osteoporosis and fracture is low for patients with uveitis but young males are at risk. Patients at high risk should be identified, and prophylaxis and treatment should be used as required. The guideline of the National Osteoporosis Society is recommended as a management protocol.

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“…O uso combinado de cálcio e vitamina D parece ser melhor do que o uso isolado destas substâncias nos pacientes com osteoporose induzida por corticosteróides, com ganho diferencial de massa óssea de 3,2% (40) . Em pacientes portadores de artrite reumatóide e em uso de corticosteróides, a combinação do uso de cálcio 1,0 grama diária, mais 500 UI de vitamina D3 levou a um aumento da densidade mineral óssea na coluna lombar de 0,72% ao ano, comparado a uma perda de 2% por ano no grupo placebo (41) . O uso da combinação de cálcio com vitamina D não parece suficiente para prevenção da perda de massa óssea nos pacientes com artrite reumatóide, quando estes estão sob regime de tratamento com doses elevadas de corticosteróides por tempo prolongado (42) .…”

Section: Erosões óSseas Subcondraisunclassified

Osteoporose e erosões osseas focais na artrite reumatóide: da patogênese ao tratamento

Pereira¹,

Pereira²

2004

Rev. Bras. Reumatol.

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Rev Bras Reumatol, v. 44, n. INTRODUÇÃOA artrite reumatóide afeta aproximadamente 0,5% a 1% da população e determina um custo social e econômico importante, considerando o grau de incapacidade para o trabalho e também o aumento da mortalidade decorrente desta doença (1,2,3) . O envolvimento ósseo na artrite reumatóide inclui a osteopenia justa-articular, as erosões ósseas e a osteoporose generalizada que acomete tanto o esqueleto axial quanto o esqueleto apendicular. A osteoporose constitui um problema clínico importante nos pacientes com artrite reumatóide, acometendo 30% a 50% dos pacientes, mesmo que estes não tenham utilizado corticosteróides, tendo como conseqüência um aumento importante do número de fraturas (4,5) .

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Calcium and Vitamin D₃Supplementation Prevents Bone Loss in the Spine Secondary to Low-Dose Corticosteroids in Patients with Rheumatoid Arthritis

Abstract: 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.

Cited by 299 publications

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Use of a Computerized Order Set to Increase Prescription of Calcium and Vitamin D Supplementation in Patients Receiving Glucocorticoids

Use of a Computerized Order Set to Increase Prescription of Calcium and Vitamin D Supplementation in Patients Receiving Glucocorticoids

Corticosteroid-induced osteoporosis in patients with uveitis

Osteoporose e erosões osseas focais na artrite reumatóide: da patogênese ao tratamento

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Calcium and Vitamin D3Supplementation Prevents Bone Loss in the Spine Secondary to Low-Dose Corticosteroids in Patients with Rheumatoid Arthritis

Abstract: 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.

Cited by 299 publications

References 0 publications

Use of a Computerized Order Set to Increase Prescription of Calcium and Vitamin D Supplementation in Patients Receiving Glucocorticoids

Use of a Computerized Order Set to Increase Prescription of Calcium and Vitamin D Supplementation in Patients Receiving Glucocorticoids

Corticosteroid-induced osteoporosis in patients with uveitis

Osteoporose e erosões osseas focais na artrite reumatóide: da patogênese ao tratamento

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Calcium and Vitamin D₃Supplementation Prevents Bone Loss in the Spine Secondary to Low-Dose Corticosteroids in Patients with Rheumatoid Arthritis