Glucocorticoid-induced osteoporosis in the lumbar spine, forearm, and mandible of nephrotic patients: A double-blind study on the high-dose, long-term effects of prednisone versus deflazacort

Abstract

The long-term effects of high dose steroid treatment with either prednisone (PDN) or deflazacort (DFZ) were examined on various parts of the skeleton in 29 patients with nephrotic syndrome. All had normal skeleton at the start of the steroid treatment. At the beginning, PDN was given as 80 mg/day and tapered down to 20 mg/day for 1 year and DFZ was given in an equipotent dosage. Twenty-three patients completed 6 months of treatment, and 18 patients completed 12 months of treatment. Beside laboratory parameters to ensure the effect of treatment on the nephrotic syndrome, all had measurements of the bone mineral content (BMC) at 0, 6, and 12 months of treatment. BMC was measured by single photon absorptiometry of both forearms and by dual photon absorptiometry of the mandible, forearms, and lumbar spine. The effect of DFZ was compared to that of PDN due to a potential "calcium sparing" effect of DFZ. The therapeutical effects on the nephrotic syndrome were not different between the two drugs. Urinary 24-hour protein decreased from 9.9 to 1.1 g in the DFZ-treated patients and from 8.0 to 1.4 g in the PDN-treated patients. Plasma albumin concentration normalized in both groups. Both groups of steroid-treated patients had a significant reduction of the BMC levels in all parts of the skeleton. However, the bone decay rates per month were significantly different between different bone regions and between different drug regimes. In the forearm, the bone decay rate was 5.3%/year in the PDN group and 2.0%/year in the DFZ group (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

A controlled study of deflazacort in the treatment of idiopathic nephrotic syndrome

“…Olgaard et al [5] found a similar efficacy of high doses of both drugs in terms of reduction of proteinuria. Piccoli et al [15], using the same equipotent ratio as in the present study, found a greater efficacy of DFZ in a short-term (2 × 5 weeks) crossover study.…”

“…Deflazacort (DFZ), a synthetic heterocyclic oxazoline glucocorticoid, was shown to be as effective as prednisone (PDN) in diseases such as rheumatoid arthritis [1][2][3], juvenile chronic arthritis [4], adult nephrotic syndrome [5], perhaps asthma [6], and also in kidney [7] and heart [8] transplantation, with a lower overall incidence of adverse effects, as recently reviewed by Markham and Bryson [9]. Children with the nephrotic syndrome seemed to develop fewer side effects of steroid therapy under DFZ in an uncontrolled study [10], and it appeared important to go further.…”

Bone histology in steroid-treated children with non-azotemic nephrotic syndrome

“…This seems particularly pertinent to corticosteroid-dependent NS, since a proportion of these patients may eventually develop renal insufficiency and ESRD [19,30], with consequent renal osteodystrophy [20], and eventually may require renal transplantation with further exposure to corticosteroid therapy and risk of fractures [51]. Reports on the use of growth hormone [52], bone-sparing corticosteroids like deflazacort [53], calcitonin, and vitamin D [54], and more recently bisphosphonates [55] are encouraging. However, long-term longitudinal studies evaluating peak bone mass and possibly bone histomorphometry in patients with prolonged NS are needed.…”

Bone densitometry in the clinical practice

“…A similar rebound increase in boneforming activity also occurs following the discontinuation of chronic glucocorticoid therapy [73]. Deflazacort, a recently developed oxazoline derivative of prednisolone, has been reported to have reduced damaging effects on bone mass relative to its antiinflammatory actions [74]. Short-term studies have shown a stimulatory effect of nandrolone deconate (Table 3) on bone density in postmenopausal women on glucocorticoids [75].…”