Primary Prevention of Glucocorticoid-Induced Osteoporosis with Intermittent Intravenous Pamidronate: A Randomized Trial

Abstract

The aim of this study was to assess whether early intermittent I.V. administration of disodium pamidronate can effectively achieve primary prevention of glucocorticoid-induced osteoporosis (GIOP). A total of 27 in- or outpatients who required first-time, long-term corticosteroid therapy at a daily dose of at least 10 mg prednisolone were studied. Patients were randomly selected to receive either pamidronate and calcium or calcium alone. Patients allocated to pamidronate treatment (pamidronate group) received a first intravenous infusion of 90 mg pamidronate simultaneously with the initiation of their steroid treatment. Subsequently, they received 30 mg pamidronate, intravenously, every 3 months, for as long as steroid therapy was continued. As with the control patients (calcium group), they were put on a daily 800-mg elemental calcium supplement given as calcium carbonate. Lumbar spine and hip (total and subregions) bone mineral densities (BMDs) were measured at the start and every 3-months by dual-energy X-ray absorptiometry (Hologic(R) QDR-2000). Over 1 year, the pamidronate group showed a significant BMD increase in the lumbar spine (3.6%), and at all sites of the hip (2.2% at the femoral neck). In the calcium group, a significant BMD reduction was registered at the lumbar spine (-5.3%) and at the femoral neck (-5.3%). Differences between the groups were significant at all sites measured. Intermittent intravenous pamidronate effectively achieves primary prevention of GIOP, as assessed by BMD measurements over 1 year.

The Epidemiology of Corticosteroid-Induced Osteoporosis: a Meta-analysis

“…The GPRD study findings are consistent with the high rate of new vertebral fractures within the first year of CS therapy found in four randomized clinical trials, with the rate in the calcium-treated placebo group ranging from 8 to 17% [106][107][108][109]. However, the finding of rapid onset of fracture was not observed in two smaller studies [110,111].…”

A randomized controlled trial of calcium with vitamin D, alone or in combination with intravenous pamidronate, for the treatment of low bone mineral density associated with Crohn's disease

“…16 In addition, half of the patients received 30 mg of disodium pamidronate (Novartis), given as an intravenous infusion over 1 h in 150 mL normal saline every 3 months, the same regimen as used in other studies to treat postmenopausal osteoporosis 21 and to prevent steroid-induced osteoporosis. 22 All patients were reviewed every 3 months when compliance and tolerance to the medication were evaluated and biochemical monitoring was performed.…”

Glucocorticosteroid-induced spinal osteoporosis: scientific update on pathophysiology and treatment

“…Intravenous cyclical pamidronate in combination with a calcium supplement was shown to protect patients beginning GC therapy from GC-induced bone loss [11,12] and to increase BMD in patients with low bone mass treated with GCs [107].…”