Intermittent Etidronate Therapy to Prevent Corticosteroid-Induced Osteoporosis

Adachi, Jonathan D.; Bensen, W.; Brown, Jacques P.; Hanley, David A.; Hodsman, Anthony B.; Josse, Robert G.; Kendler, David L.; Lentle, Brian C.; Olszynski, W. P.; Ste‐Marie, Louis‐Georges; Tenenhouse, Alan; Chines, Arkadi

doi:10.1056/nejm199708073370603

Cited by 656 publications

(327 citation statements)

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“…35 A randomized controlled study using 12 months of etidronate and calcium therapy reported prevention of bone loss and vertebral fractures in 141 patients receiving high-dose corticosteroids. 36 However, there are few studies in the post-OLT setting. A trial of calcitonin in the first 6 months after OLT was not useful in preventing post-OLT bone loss, 37 although a combination of calcitonin and biphosphonates for 12 months after OLT showed some improvement in BMD.…”

Section: Discussionmentioning

confidence: 99%

Evidence of continuing bone recovery at a mean of 7 years after liver transplantation

et al. 1999

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Patients with end-stage liver disease have low bone-turnover osteoporosis, and there is often further bone loss of 20% to 30% after orthotopic liver transplantation (OLT). Bone recovery after OLT has been reported, but data are limited. We undertook studies to determine whether bone recovery continues in the long term. Twenty-eight adult patients alive at least 5 years after OLT were studied (14 men, 14 women). Bone mineral density (BMD), serum parathyroid hormone (PTH), osteocalcin, and vitamin D levels were measured pretransplantation, at 3 months, 12 months, a mean of 46 months, and a mean of 85 months (range, 63 to 117 months) after transplantation. When BMD is expressed as a z score, the results were as follows: ؋0.82 ؎ 0.22 pre-OLT; ؊2.04 ؎ 0.27 at 3 months; ؊1.68 ؎ 0.24 at 12 months; ؊1.23 ؎ 0.24 at a mean of 46 months; and ؊1.0 ؎ 0.26 at a mean of 85 months after OLT. The results at 46 and 85 months were significantly greater than the measurement at 3 months after OLT (P F .05). Furthermore, mean BMD (expressed as a z score) returns to the pre-OLT level at a mean of 85 months. At final follow-up, 9 of 28 patients had elevated PTH levels, and 14 of 27 patients had elevated osteocalcin levels. Five patients had spontaneous fractures in the first 12 months after transplantation, and 5 more patients had fractures by final follow-up. Even at 7 years after OLT, there was a significant increase in BMD (expressed as a z score) compared with 3 months after transplantation. Elevation of serum PTH and osteocalcin levels in some patients suggests continuing bone remodeling.

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Section: Discussionmentioning

confidence: 99%

Evidence of continuing bone recovery at a mean of 7 years after liver transplantation

et al. 1999

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“…Unfortunately, even small doses of administered cyclical hormones resulted in exacerbation of the patient's premenstrual asthma. The osteopenia of oestrogen deficiency can be treated with bisphosphonates [6]. An alternative strategy would be the use of continuous HRT preparations in order to avoid hormonal fluctuations but this has yet to be explored.…”

Section: Discussionmentioning

confidence: 99%

Gonadotrophin-releasing hormone analogues: a novel treatment for premenstrual asthma

et al. 1999

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Gonadotrophin-releasing hormone analogues: a novel treatment for premenstrual asthma. R.D. Murray, J.P. New, P.V. Barber, S.M. Shalet. #ERS Journals Ltd 1999. ABSTRACT: Premenstrual exacerbation of asthma, as reflected by a reduction in peak expiratory flow rate (PEFR), has been demonstrated in 40±100% of female asthmatics. Epidemiological data demonstrate that admission to hospital with an exacerbation of asthma occurs more frequently perimenstrually. Therapeutic interventions aimed at modifying this precipitating factor, however, remain limited.We report on a 32-yr old female with asthma in whom a marked increase in symptoms and reduction in PEFR occurred premenstrually, necessitating recurrent admissions to hospital. Frequent severe exacerbations resulted in the chronic use of oral maintenance corticosteroids. In order to suppress gonadotrophin secretion and ovarian function, a long-acting gonadotrophin-releasing hormone analogue was administered with a view to inducing a reversible menopause. This resulted in improvement in respiratory symptoms, the absence of PEFR dips premenstrually, a reduction in maintenance prednisolone dosage and no further hospital admissions during a follow-up period of 14 months.The authors propose that gonadotrophin-releasing hormone-analogue therapy is a rational and innovative adjuvant treatment worthy of further study in cases of severe premenstrual asthma. Eur Respir J 1999; 14: 966±967. Premenstrual exacerbation of asthma, as reflected by a reduction in peak expiratory flow rate (PEFR), has been demonstrated in 40±100% of asthmatics [1,2]. Clinically, this may remain silent if the deterioration in respiratory function is minor or respiratory reserve is great, and therefore may not result in limitation of normal activity. Further supportive evidence for the importance of menstrual cyclicity in airway reactivity is derived from epidemiological data, demonstrating that admission to hospital with exacerbation of asthma occurs more frequently perimenstrually [3].Therapeutic strategies aimed at modifying this precipitating factor are currently limited; BEYNON et al. [4] described the successful use of intramuscular progesterone, as demonstrated by an improvement in PEFR and reduction in maintenance prednisolone dosage, in three cases of severe premenstrual asthma. For asthma severity to be cyclical, it is likely to be related to the fluctuations in or absolute concentrations of oestrogen or progesterone. It could therefore be hypothesized that gonadotrophin-releasing hormone (Gn-RH) analogues by suppression of gonadotrophin and ovarian function, with a view to inducing a premature but reversible menopause, would result in elimination of the premenstrual deterioration in asthma control. Case studyA 32-yr old female with a long-standing history of asthma presented with a 4-yr history of worsening symptoms requiring continuous treatment with oral prednisolone. Three years prior to presentation she had noted that the exacerbations were temporally related to her menstrual cycle, occurri...

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“…In another study in post-menopausal women, the cyclic administration of etidronate in combination with the vitamin D metabolite ergocalciferol increased lumbar spine and femoral neck BMD by 7 and 2.5% respectively, in the first year of GC therapy, while in the second year BMD continued to increase at the femoral neck and remained stable at lumbar spine [29]. Furthermore, in a randomized placebo-controlled trial, 141 men and women recently started on GC therapy were treated for 1 year with either etidronate (400 mg/day) or placebo for 14 days, followed by calcium (500 mg/day) for 76 days: with etidronate bone density increased significantly at lumbar spine and trochanter, but not at the femoral neck [1]. Similar results were reported in another study with 117 patients followed over 1 year [119].…”

Section: Calcium Vitamin D and Thiazide Diureticsmentioning

confidence: 99%

“…In a recently published study over 5 years, including 352 patients who had been taking GCs for at least 1 year for the treatment of asthma, cyclical etidronate caused a significant increase in lumbar spine BMD [16]. Although the results on BMD were consistent across studies, reduction of fracture risk could not be established with etidronate [1,16].…”

Section: Calcium Vitamin D and Thiazide Diureticsmentioning

confidence: 99%

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

et al. 2006

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Intermittent Etidronate Therapy to Prevent Corticosteroid-Induced Osteoporosis

Abstract: Intermittent etidronate therapy prevents the loss of vertebral and trochanteric bone in corticosteroid-treated patients.

Cited by 656 publications

References 14 publications

Evidence of continuing bone recovery at a mean of 7 years after liver transplantation

Evidence of continuing bone recovery at a mean of 7 years after liver transplantation

Gonadotrophin-releasing hormone analogues: a novel treatment for premenstrual asthma

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

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