Glucocorticoid‐induced osteoporosis: pathogenesis, prevention and treatment, with special regard to the rheumatic diseases

Olbricht, Th.; Benker, G.

doi:10.1111/j.1365-2796.1993.tb00738.x

Cited by 45 publications

(17 citation statements)

References 65 publications

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“…It is well known that they have a negative effect on bone tissue [2,3], which may lead to bone loss and, ultimately, to osteoporotic fractures [4,5].…”

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confidence: 99%

Treatment of Glucocorticoid-Induced Osteoporosis with Alfacalcidol/Calcium Versus Vitamin D/Calcium

et al. 1999

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Vitamin D/calcium substitution is generally regarded as an effective first step treatment for glucocorticoid-induced osteoporosis (GIOP). The aim of our study was to evaluate the efficacy of the active vitamin D metabolite alfacalcidol (1alpha) compared with the native vitamin D(3) in patients with established GIOP with or without vertebral fractures. Patients on long-term corticoid therapy were given either 1 microg alfacalcidol plus 500 mg calcium per day (group A, n = 43) or 1000 IU vitamin D(3) plus 500 mg calcium (group B, n = 42). The two groups were alike in age range, sex ratio, percentages of underlying diseases, average initial bone density values (lumbar spine: mean T-score -3.28 and -3.25, respectively), and rates of vertebral and nonvertebral fractures. During the 3-year study we found a small but significant increase of lumbar spine density in group 1alpha (+2.0%, P < 0.0001) and no significant changes at the femoral neck. In the D(3) group, there were no significant changes at both sites. At the end of the study, 12 new vertebral fractures had occurred in 10 patients of the group 1alpha and 21 in 17 patients of the D(3) group. In accordance with the observed fracture rates, the alfacalcidol group showed a significant decrease in back pain (P < 0.0001) whereas no change was seen in the vitamin D group. We conclude that with the doses used in this trial, alfacalcidol is superior to vitamin D in the treatment of established GIOP.

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“…It is well known that they have a negative effect on bone tissue [2,3], which may lead to bone loss and, ultimately, to osteoporotic fractures [4,5].…”

mentioning

confidence: 99%

Treatment of Glucocorticoid-Induced Osteoporosis with Alfacalcidol/Calcium Versus Vitamin D/Calcium

et al. 1999

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“…[1][2][3] Treatment with alfacalcidol (1α-OH-vitamin D 3 ) has been shown to be effective in preventing corticosteroid-induced osteoporosis, 4,5 and is therefore frequently used. Most of the toxic effects of alfacalcidol, including appetite loss, nausea, constipation, liver dysfunction, renal dysfunction, ectopic calcification, and hypercalcemia, are not serious and disappear shortly after the discontinuation of alfacalcidol.…”

Section: Introductionmentioning

confidence: 99%

Congestive heart failure and axonal polyneuropathy induced by alfacalcidol in a patient with systemic lupus erythematosus

Kikuchi¹,

Aramaki²,

Hirohata³

2003

Modern Rheumatology

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We describe the case of a 29-year-old woman with systemic lupus erythematosus (SLE), who developed congestive heart failure and severe axonal polyneuropathy after 9 months of treatment with alfacalcidol for the prevention of corticosteroid-induced osteoporosis. There was no evidence for the exacerbation of SLE. Moreover, both congestive heart failure and axonal polyneuropathy improved after discontinuation of the alfacalcidol without increasing the dose of corticosteroid. Since alfacalcidol is commonly used in the prevention of corticosteroid-induced osteoporosis, rheumatologists should be aware of the presence of this life-threatening adverse effect.

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“…Adverse events related to the corticosteroid treatment are not reduced by alternate-day administration, and there are some conflicting results about the effects of daily dose, cumulative dose and duration of corticosteroid treatment on the rate of bone loss (4,9). The aim of this study was to determine the relationship between BMD and cumulative corticosteroid dose in MS patients.…”

Section: Introductionmentioning

confidence: 99%

Cumulative Corticosteroid Doses and Osteoporosis in Patients with Multiple Sclerosis

2010

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Objective: Multiple sclerosis (MS) is an inflammatory demyelinating disorder and corticosteroids used for the treatment of attacks are known to cause osteoporosis. Although osteoporosis is a known potential complication, many patients do not receive treatment to prevent bone loss. The aim of this study was to assess the relationship between cumulative doses of corticosteroids and bone mineral density (BMD) in MS patients. Materials and Methods: Twenty-two patients with MS (15 women, 7 men) and 22 age-and sex-matched subjects were enrolled into the study. Lumbar and femoral BMDs were measured using dual energy X-ray absorptiometry (DXA). Mobility and ambulation scales were also evaluated. Corticosteroid use was determined from an interviewer-administered questionnaire and patient records. Result: Lumbar and femoral BMDs were significantly lower in MS patients compared to the control group (p<0.05). 18.2% of the MS patients had no restriction in activities of normal employment and domestic life when assessed with Kraft Mobility Scale. Only 22.7% of the MS patients were fully ambulant when evaluated with Scranton Ambulation Scale. Cumulative dose was negatively correlated with lumbar BMD measurements (r=-0.505, p=0.017). Conclusion: Corticosteroids are an important part of the MS therapy and their use results in osteoporosis. Thus, cumulative corticosteroid dose should be determined and BMD measurements of the patients should be taken before treatment to determine those at high risk of osteoporosis, and preventive measures should be undertaken. (Turk J Rheumatol 2010; 25: 191-5

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Glucocorticoid‐induced osteoporosis: pathogenesis, prevention and treatment, with special regard to the rheumatic diseases

Cited by 45 publications

References 65 publications

Treatment of Glucocorticoid-Induced Osteoporosis with Alfacalcidol/Calcium Versus Vitamin D/Calcium

Treatment of Glucocorticoid-Induced Osteoporosis with Alfacalcidol/Calcium Versus Vitamin D/Calcium

Congestive heart failure and axonal polyneuropathy induced by alfacalcidol in a patient with systemic lupus erythematosus

Cumulative Corticosteroid Doses and Osteoporosis in Patients with Multiple Sclerosis

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