Prevention of glucocorticoid-induced osteopenia: Effect of oral 25-hydroxyvitamin D and calcium

Abstract

Twenty-four patients (9 M and 15 F, age range 51-82) with polymyalgia rheumatica receiving 6-methylprednisolone for a period of 9 months (16 mg/daily/two weeks, 14 mg/daily/two weeks, 12 mg/daily/1 month, 10 mg/daily/1 month, 8 mg/daily/1 month, 6 mg/daily/1 month and 4 mg/daily for the last four months) were randomly assigned to receive either 250HD3 (35 mcg/day for 25 days/month) (Group A) or placebo (Group B) in a double-blind study. All patients also received 500 mg elemental calcium daily. Before and at 3, 6 and 9 months ESR, tenderness on palpation and subjective pain were evaluated. At the same times, mineral metabolism parameters (serum calcium, phosphorus, alkaline phosphatase, 24-h urinary calcium, phosphate and 24-h hydroxyproline excretion) and radial bone mineral content (BMC) were evaluated. Activity indexes (ESR and clinical parameters) improved in both groups. Furthermore, serum alkaline phosphatase and 24-h hydroxyproline excretion decreased significantly only in Group A, and BMC decreased significantly in Group B but rose slightly in Group A. No side effects were observed in any of the patients.

Vitamin D for the treatment of chronic painful conditions in adults

“…Adverse events were infrequent and occurred at similar rates with vitamin D and placebo (Di Munno 1989;Yamauchi 1989; Table 2). …”

“…Included studies-Four studies were included (Brohult 1973;Di Munno 1989;Warner 2008;Yamauchi 1989) with a total of 294 participants. Full details are in the "Characteristics of included studies" table.…”

“…Three older studies (Brohult 1973;Di Munno 1989;Yamauchi 1989) had lower Oxford Quality Scores and were potentially prone to bias. Points were lost mainly due to failure to adequately describe methods of randomisation and blinding.…”

“…Four studies could be included (Brohult 1973;Di Munno 1989;Warner 2008;Yamauchi 1989) with a total of 294 participants. These studies investigated the effects of four different regimens of vitamin D administration, in participants with three different chronic pain conditions, from four different countries, were conducted at different times, and reported on different outcomes.…”

“…A trial of 25-hydroxy vitamin D (35 μg per day for 25 days a month) in participants with polymyalgia rheumatica over 9 months (Di Munno 1989) found that subjective pain on movement decreased in both vitamin D and placebo groups over time, with little difference between the groups (no statistics for between group comparisons reported). A recent study of 50,000 IU ergocalciferol for the treatment of diffuse musculoskeletal pain over 3 months (Warner 2008) investigated pain with a visual analogue scale (VAS) -finding no significant difference between vitamin D and placebo groups -and with a functional pain score -with an outcome that slightly favoured placebo in one comparison (Table 1).…”