Therapy of steroid-induced bone loss in adult asthmatics with calcium, vitamin D, and a diphosphonate.

Abstract

In a prospective, controlled, and randomized clinical trial, we examined the effects of treatment with vitamin D (1,000 IU/d), calcium (1 g/d), and ethane-1-hydroxy-1,1-diphosphonate (EHDP; 7.5 mg/kg body weight) on vertebral bone mass in fourteen asthmatics undergoing long-term treatment with systemically applied corticosteroids. The extent of steroid-induced bone loss was judged by vertebral bone density of the lumbar spine measured by dual-photon absorptiometry as well as by vertebral crush fracture incidence examined by conventional X-ray. Results of the measurements before treatment and after six mo were compared with those of an untreated control group of nineteen asthmatics. Bone density increased during the observation period by 5% in the treated group, compared with a decrease of 4.3% in the untreated control group (p < 0.01). Moreover, in the treated group no radiologically visible new fractures occurred; in the control group new fractures were observed in four patients. There were no serious side effects of the applied drugs during the 6-mo period. Therefore, the combination of EHDP, calcium, and vitamin D appears to be a useful regimen for the management of steroid-induced bone loss in adult asthmatics.

Effect of inhaled corticosteroids on bones and growth

“…Bone formation and resorption may both play a major role in the development of osteopenia, but it has become clear that the coupling mechanism between the two is more important [13,14]. Individual biochemical markers, therefore, are likely to be of limited value and also seem largely to reflect on an individuals most recent corticosteroid exposure rather than to any important cumulative effect [14][15][16][17][18][19].…”

A placebo-controlled study of three osteocalcin assays for assessment of prednisolone-induced suppression of bone turnover

“…The duration of suppression after withdrawal of several days of treatment, however, has not previously been assessed. This is an important factor to consider since a cumulatative suppresssive effect may play a key role in the early and rapid bone loss which occurs during treatment with exogenous corticosteroids (Reid 1989, LoCascio et al 1990, Worth et al 1994). The present findings have provided evidence that 4 days after withdrawal of a 3-day course of prednisolone (20 mg twice daily) bone turnover is unaffected.…”

Effects of inhaled corticosteroids on bone

“…l). These changes lead to secondary osteoporosis and a rise in (non-traumatic) fracture incidence [19,20,24].…”

“…Data suggest that bone loss is most pronounced in the early weeks of OCS therapy with subsequent slowing during prolonged treatment [48]. Up to 50% of patients on maintenance treatment with OCS may experience (non-traumatic) fractures in the long term [19,20,24,48].…”