The treatment of osteoporosis in patients with rheumatoid arthritis receiving glucocorticoids: a comparison of alendronate and intranasal salmon calcitonin

Taşçıoğlu, Funda; Çolak, Ömer; Armağan, Onur; Alataş, Özkaņ; Oner, Cengiz

doi:10.1007/s00296-004-0496-3

Cited by 30 publications

(15 citation statements)

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“…Eleven trials were classified as treatment trials because BPs was given for long-term GC user. Of these 11 treatment trials, the mean dosage of GC consumption was greater than 7.5 mg/day (prednisone equivalent) in 6 trials [19], [38], [46]–[49], less than 7.5 mg/day in 5 trials [20], [21], [39], [40], [43]. No GC usage in 1 trial [37].…”

Section: Resultsmentioning

confidence: 99%

“…No GC usage in 1 trial [37]. calcium and vitamin D was given to patients in 10 trials [19], [21], [22], [38]–[40], [43], [45]–[47], only calcium in 5 trials [34], [36], [41], [42], [49], only placebo in 5 trial [20], [33], [37], [44], [48].…”

Section: Resultsmentioning

confidence: 99%

“…All the included trials were randomized and 9 were double blinded (Table S1). We contacted authors for detailed study information, including randomization, blinding, and description of withdrawals for Jadad score evaluation in 9 trials [19]–[21], [36], [38], [39], [43], [48], [49]. Only authors of three papers responded with favorable information [20], [43], [49].…”

Section: Resultsmentioning

confidence: 99%

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Bisphosphonates for the Prevention and Treatment of Osteoporosis in Patients with Rheumatic Diseases: A Systematic Review and Meta-Analysis

et al. 2013

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BackgroundWhile bisphosphonates (BPs) are commonly used in clinical treatment for osteoporosis, their roles on osteoporosis treatment for rheumatic patients remain unclear. We performed a meta-analysis to evaluate the efficacy of BPs on fractures prevention and bone mass preserving in rheumatic patients.Methodology/Principal FindingsWe searched PubMed, EmBase, and the Cochrane Central Register of Controlled Trials for relevant literatures with a time limit of Jan. 6, 2012. All randomized clinical trials of BPs for adult rheumatic patients with a follow-up of 6 months or more were included. We calculated relative risks (RRs) for fractures and weighted mean difference (WMD) for percent change of bone mineral density (BMD). Twenty trials were included for analysis. The RR in rheumatic patients treated with BPs was 0.61 (95%CI [0.44, 0.83], P = 0.002) for vertebral fractures, and 0.49 (95%CI [0.23, 1.02], P = 0.06) for non-vertebral fractures. The WMD of BMD change in the lumbar spine was 3.72% (95%CI [2.72, 4.72], P<0.001) at 6 months, 3.67% (95%CI [2.84, 4.50], P<0.001) at 12 months, 3.64% (95%CI [2.59, 4.69], P<0.001) at 24 months, and 5.87% (95%CI [4.59, 7.15], P<0.001) at 36 months in patients using BPs, as compared with those treated with calcium, vitamin D or calcitonin. In subgroup analyses, rheumatic patients using BPs for osteoporosis prevention had greater WMD than those using BPs for treating osteoporosis at 6 months (4.53% vs. 2.73%, P = 0.05) and 12 months (4.93% vs. 2.91%, P = 0.01).Conclusions/SignificanceIn both short-term and middle-term, BPs can preserve bone mass and reduce the incidence of vertebral fractures in rheumatic patients, mainly for those who have GC consumption. The efficacy of BPs is better when using BPs to prevent rather than to treat osteoporosis in rheumatic patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Bisphosphonates for the Prevention and Treatment of Osteoporosis in Patients with Rheumatic Diseases: A Systematic Review and Meta-Analysis

et al. 2013

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“…A Cochrane review assessing the efficacy of calcitonin for treatment and prevention of GIOP demonstrated preservation in lumbar BMD at 12 months, but not at 24 months compared to placebo [73]. One study found that alendronate was significantly better than intranasal calcitonin at increasing BMD and decreasing bone turnover [74]. There is also a concern for increased risk of malignancy such as basal cell carcinoma and prostate cancer, although the data is not strong for a causal relationship [75].…”

Section: And Calcitoninmentioning

confidence: 91%

Prevention and Treatment of Bone Disease in Systemic Lupus Erythematosus

Lin

Grossman

2016

Curr Treat Options in Rheum

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Opinion statementSystemic lupus erythematosus (SLE), an autoimmune chronic inflammatory disease, can be associated with significant morbidity and mortality of which bone disease such as osteoporosis is a contributor. Patients with SLE are at risk for low bone mineral density (BMD) due to a variety of reasons including inflammation, glucocorticoid use, vitamin D deficiency, premature ovarian failure, increased damage, and traditional risk factors such as age and gender. With better treatments for SLE, survival has improved; therefore, complications from morbidity including osteoporosis need better prevention and treatment strategies. In SLE patients with osteoporosis or those on glucocorticoids who meet guidelines for therapeutic intervention, we prefer bisphosphonates as first-line therapy for most patients. They have proven efficacy in increasing BMD and decreasing fracture risk, known safety profiles, and have a favorable cost-effectiveness profile. The newer agents, teriparatide and denosumab, have not only demonstrated improvement in BMD but also decreased risk of fracture. We typically recommend these medications for some high-risk populations, those who have failed bisphosphonate therapy or those who are intolerant of oral bisphosphonates. Estrogen-containing drugs are not recommended for first-line prevention and treatment of osteoporosis given the elevated risk of cardiovascular disease. Calcitonin has also been used in osteoporosis; however, the bisphosphonates and newer drugs have proven to be more efficacious. Supplementation with calcium and vitamin D is recommended in particular with those patients who are vitamin D deficient and those on glucocorticoids, although data documenting fracture prevention with this strategy is limited. Therapeutic strategies for premenopausal women of child-bearing potential remain controversial because of limited data about safety in subsequent pregnancies. Decisions for these patients need to be made on a case by case basis weighing the risks and benefits to the individual patient. Future therapies targeting different mechanisms within bone resorption and formation are currently under investigation and will significantly add to our limited armamentarium.

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“…Eine Steigerung der Knochendichte bei GIO konnte auch bei der Anwendung von Calcitonin beobachtet werden [2]. Jedoch fallen die Effekte im Vergleich zu den Bisphosphonaten geringer aus [21].…”

Section: Weitere Möglichkeiten Der Therapieunclassified

Grundlagen und Management der glukokortikoidinduzierten Osteoporose

Willenberg

Lehnert

2008

Internist

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Glucocorticoids interfere with bone metabolism at different levels. Therefore, glucocorticoid-induced osteoporosis (GIO) is the most frequent form of secondary osteoporosis and up to 50 percent of patients on chronic glucocorticoid therapy suffer fractures. This is also because GIO is still under-diagnosed and not adequately treated. Besides, the fracture risk is higher in GIO than in primary osteoporosis even in the presence of equal bone mass density. The risk of osteoporotic fractures increases with dose and duration of glucocorticoid therapy, although the loss of bone mass is more prominent within the first three to twelve months after initiation of treatment. Besides glucocorticoid treatment, other factors, such as e.g. the underlying disease, substantially influence the fracture risk. Therefore, a diagnostic screening is mandatory in each case and should include the patient's history, physical examination, laboratory studies, evaluation of the bone-mass density by dual X-ray absorptiometry and imaging of the spine. Education of the patients and pharmacological prevention are very important, antiresorptive therapy has to be started earlier than in primary osteoporosis and osteoanabolic agents have also been proven to be effective.

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The treatment of osteoporosis in patients with rheumatoid arthritis receiving glucocorticoids: a comparison of alendronate and intranasal salmon calcitonin

Abstract: The results of this study demonstrated that alendronate treatment produced significantly greater increases in the femoral neck BMD and greater decreases in bone turnover than intranasal sCT in RA patients receiving low dose glucocorticoids.

Cited by 30 publications

References 34 publications

Bisphosphonates for the Prevention and Treatment of Osteoporosis in Patients with Rheumatic Diseases: A Systematic Review and Meta-Analysis

Bisphosphonates for the Prevention and Treatment of Osteoporosis in Patients with Rheumatic Diseases: A Systematic Review and Meta-Analysis

Prevention and Treatment of Bone Disease in Systemic Lupus Erythematosus

Grundlagen und Management der glukokortikoidinduzierten Osteoporose

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