Prevention of Corticosteroid Osteoporosis -- A Comparison of Calcium, Calcitriol, and Calcitonin

Sambrook, Philip N.; Birmingham, J; Kelly, Paul; Kempler, S; Nguyen, Tuan V.; Pocock, Nicholas; Eisman, John A.

doi:10.1056/nejm199306173282404

Cited by 482 publications

(269 citation statements)

References 38 publications

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“…Based on changes in lumbar spine BMD, calcitriol (mean dose 0.6 lg/day), with and without calcium, was significantly more efficacious than calcium in preventing bone loss ()0.2 and )1.3% per year vs. )4.3% per year, P=0.0035) but had no effect at other clinically important sites such as femoral neck and distal radius. Similar results were reported by other authors [125] and with other active vitamin D metabolites such as alfacalcidol [13,101,112,113].…”

Section: Calcium Vitamin D and Thiazide Diureticssupporting

confidence: 91%

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

et al. 2006

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Section: Calcium Vitamin D and Thiazide Diureticssupporting

confidence: 91%

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

et al. 2006

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“…Calcium and vitamin D supplementation have been shown to ameliorate bone loss 26 and bisphosphonates unarguably reduce bone loss and replenish bone once lost. 5,27 Other drugs such as calcitriol 28 and calcitonin 29 prove beneficial in some circumstances. However, the only adverse event associated with bone loss is bone fracture, and the effect of prophylaxis on fracture prevalence has not been conclusively established.…”

Section: Discussionmentioning

confidence: 99%

Corticosteroid-induced osteoporosis in patients with uveitis

Jones

Anderton

Whallett

et al. 2002

Eye

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Aims To estimate the prevalence of low bone density and osteoporosis in a population of patients with uveitis taking systemic steroid treatment; to clarify the risks of steroid-induced fracture and to suggest a protocol for the prevention and management of bone loss in patients with ophthalmic inflammatory disease. Methods Bone densitometry was performed on 129 adult patients with prednisolonetreated uveitis from four centres. Information on uveitis diagnosis, associated risk factors, steroid dosage and treatment duration, prophylaxis and management, was collected. Juveniles, patients with scleritis and those who had used deflazacort, were excluded. Results Steroid treatment time varied from 13 weeks to 31 years, and the total dosage from 1.29 g to 166.5 g. Twenty-six percent of patients also used one or more immunosuppressives. Forty-eight percent had additional risk factors for bone loss. Bone density was abnormally low in 44.2%, and 15.5% had osteoporosis. Osteoporosis was substantially more common in males (20.6%, all under 60 yrs) than in females (9.8%). Seven symptomatic fractures occurred in patients on treatment. Bone loss correlated with total steroid dose, mean dose, duration of treatment and the presence of pre-existing risk factors. Conclusions The prevalence of steroidinduced osteoporosis and fracture is low for patients with uveitis but young males are at risk. Patients at high risk should be identified, and prophylaxis and treatment should be used as required. The guideline of the National Osteoporosis Society is recommended as a management protocol.

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“…The most rapid rate of bone loss occurs in the 1st year of treatment [9,101 and is similar for the lumbar spine and femoral neck. Similarly, in crosssectional studies of patients treated with corticosteroids, there was a similar decrease in bone-mineral density of the lumbar spine and femoral neck.…”

Section: The Scope Of the Problemmentioning

confidence: 96%

“…Sambrook et al [9] studied 103 patients with miscellaneous diseases within 4 weeks of the onset of treatment with prednisone, and the patients were randomized to 1 year's treatment with calcium with or without calcitriol or calcitriol plus intranasal calcitonin. They were followed up for a further year after stopping treatment.…”

Section: Primary Preventionmentioning

confidence: 99%

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Management of corticosteroid‐induced osteoporosis

Eastell

1995

Journal of Internal Medicine

115

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Abstract. Eastell R, on behalf of a UK Consensus loss is most rapid from the axial skeleton, particularly Group Meeting on Osteoporosis (Department of during the 1st year of therapy. The most important Human Metabolism and Clinical Biochemistry, mechanism for the bone loss is a decrease in University of Sheffield, Sheffield, UK). Management osteoblastic activity. Preventative strategies should of corticosteroid-induced osteoporosis (Review). J be targeted to patients with low bone-mineral denlntern Med 1995: 237: 4 3 9 4 7 . sity, especially if the dose of corticosteroids is likely to be high. Treatment strategies agreed on by the Corticosteroid therapy results in osteoporosis. There Consensus Panel included hormone replacement is a doubling in the risk of fracture in patients taking therapy and bisphosphonates, with monitoring of more than the equivalent of 7.5 mg day-'. The bone efficacy by bone densitometry.

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Prevention of Corticosteroid Osteoporosis -- A Comparison of Calcium, Calcitriol, and Calcitonin

Abstract: Calcitriol and calcium, used prophylactically with or without calcitonin, prevent corticosteroid-induced bone loss in the lumbar spine.

Cited by 482 publications

References 38 publications

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

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

Corticosteroid-induced osteoporosis in patients with uveitis

Management of corticosteroid‐induced osteoporosis

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