Comparative Studies on Effect of Risedronate and Alfacalcidol against Glucocorticoid-Induced Osteoporosis in Rheumatoid Arthritic Patients

Abstract

Osteoporosis is a common adverse reaction induced by glucocorticoid treatment. Bisphosphonate, vitamin D 3 (VD 3 ) or vitamin K 2 (VK 2 ) is recommended asˆrst or second choice of drug for treatment of glucocorticoid-induced osteoporosis. In the present study, the treatment eŠect of risedronate against glucocorticoid-induced osteoporosis in rheumatoid arthritic patients was compared with that of alfacalcidol. Twelve patients were randomized to receive either risedronate (2.5 mg) or alfacalcidol (0.5 mg) daily for 48 weeks. Each patient also received 800 mg of calcium supplementation (800 mg/day) daily. Bone mineral density (BMD) and the biochemical markers of bone turnover were measured before (baseline) and 12, 24, and 48 weeks after treatment with risedronate or alfacalcidol, and the percentage changes in these parameters from baseline were compared.The BMD values 12, 24 and 48 weeks after treatment with risedronate increased by 3.9％, 4.1％ and 5.2％, respectively, which were signiˆcantly higher than those after treatment with alfacalcidol (2.8％, 2.1％ and 2.5％, respectively). Urinary excretion of N-telopeptides of type I collagen and deoxypyridinoline after risedronate treatment were more signiˆcantly decreased than that after alfacalcidol treatment. The presentˆndings at least suggest that risedronate is more useful for the prevention and treatment of glucocorticoid-induced osteoporosis in patients with rheumatoid arthritis than alfacalcidol, although the number of patients studied was small.

Bisphosphonates for the Prevention and Treatment of Osteoporosis in Patients with Rheumatic Diseases: A Systematic Review and Meta-Analysis

“…The sample size ranged from 12 to 201 patients. Included patients were restricted to RA in 5 trials [20], [21], [37]–[39]. The average age of patients was more than 50 years in 14 trials [19]–[22], [34], [36]–[44], and younger than 50 years in 6 trials [33], [45]–[49].…”

“…Eleven trials were classified as treatment trials because BPs was given for long-term GC user. Of these 11 treatment trials, the mean dosage of GC consumption was greater than 7.5 mg/day (prednisone equivalent) in 6 trials [19], [38], [46]–[49], less than 7.5 mg/day in 5 trials [20], [21], [39], [40], [43]. No GC usage in 1 trial [37].…”

“…All the included trials were randomized and 9 were double blinded (Table S1). We contacted authors for detailed study information, including randomization, blinding, and description of withdrawals for Jadad score evaluation in 9 trials [19]–[21], [36], [38], [39], [43], [48], [49]. Only authors of three papers responded with favorable information [20], [43], [49].…”

Glucocorticoids and Vitamin D

“…Consistent with these findings, Yamada et al [88] performed a small study in Japanese patients (12 patients with rheumatoid arthritis) randomized to either low-dose risedronate (2.5 mg daily) or alfacalcidol 0.5 mg daily for 48 weeks. Lumbar spine BMD increased by 5.2% with risedronate compared to 2.5% with alfacalcidol.…”

Valoración de la influencia de diversos factores de riesgo de osteoporosis en mujeres con artritis reumatoide, tratadas con glucocorticoides

“…Estos resultados se han descrito en diversos ensayos clínicos utilizando alendronato [193], risedronato [194][195][196], ibandronato y ácido zoledrónico (estos dos últimos por vía intravenosa) [197]. De este modo, se intenta paliar los efectos adversos de los GC sobre el hueso, en las pacientes con AR, en quienes concurren numerosos factores de riesgo.…”