Prevention Of Corticosteroid-Induced Osteoporosis

Journal/Book: Z Rheumatol 1998; 57 Suppl. 1: 2 (H 6). 1998;

Abstract: Med. Klinik 4 Klinikum Leverkusen (Univ. of Cologne) Glucocorticosteroid-induced osteoporosis (GIOP) is the most frequent form of secondary osteoporoses in men and women. Although representing a very important clinical problem little therapeutic experience is documented on this condition. All antiosteoporotic agents that are approved for postmenopausal osteoporosis have also been studied in GIOP. For all substances more or less positive effects on bone density were reported while fracture data are lacking. During active corticoid therapy antiresorptive drugs are the first choice for prevention of GIOP. Among these active vitamin D metabolites are of special interest because they counteract the main pathogenetic mechanisms of corticoid-induced bone loss. The rationale for using D-metabolites is mainly to reverse the reduced intestinal calcium absorption by antagonizing the effect of corticosteroids on gut cells. This will reduce secondary hyperparathyroidism i. e. increased bone resorption. Furthermore the direct stimulatory effect of 1 alpha-hydroxylated D metabalites on osteoblasts may overcome the inhibitory effect of corticosteroids on osteoblastic activity and proliferation. Accordingly opposing effects on serum osteocalcin levels have been demonstrated for prednisone and calcitriol. In several clinical studies both alfacalcidol and calcitriol prevented spinal bone loss during corticosteroid therapy. There is evidence that 1 alphahydroxylated D metabolites do not only induce a positive bone balance and ameliorate bone quality but also have immunmodulatory antiinflammatory properties. This may reduce the risk of inflammationmediated osteopenia an important contributing factor to different forms of GIOP and is an additional argument to do further preventive or therapeutic studies with these active vitamin D-metabolites in e. g. patients with rheumatoid arthritis and Crohn's disease. In an ongoing trial we are comparing the therapeutic efficacy of 1 pg alfacalcidol plus 500 mg calcium versus 1.000 1.U. cholecalciferol plus 500 mg calcium in 70 patients with GIOP. Preliminary results after 12 and 24 months of therapy show a clear superiority of the active metabolite. le

Zurück | Weiter