Treatment of corticosteroid-induced osteoporosis with Calcium/Vitamin D versus Alfacalcidol

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

Abstract: Medizinische Klinik 4 Klinikum Leverkusen (Akadem. Lehrkrankenhaus der Univ. zu Köln) Although corticoid-induced osteoporosis (CIOP) represents a very important clinical problem little therapeutic experience is documented on this condition. In general vitamin D/calcium substitution is regarded as an effective basic treatment. The aim of our study was to evaluate the efficacy of the active metabolite alfacalcidol compared to the native vitamin D3 in patients with established CIOP with or without vertebral fractures at onset. The trial was performed as a prospective parallel-group controlled study. Patients on long-term corticoid therapy for three different conditions (chronic obstructive lung disease rheumatoid arthritis or polymyalgia rheumatica) were given either 1pg alfacalcidol plus 500 mg calcium per day (group A n = 43) or 1000 IU vitamin D plus 500 mg calcium per day (group B n = 42). The two groups were not different in terms of age range sex ratio percentages of underlying diseases average initial bone mineral density (BMD) values (lumbar spine: mean T-score -3.28 and -3.25 resp.) and rates of vertebral and non-vertebral fractures. During the three year study we found a small but significant increase of lumbar spine BMD in group A (+2.11 %) and no significant changes at the femoral neck. In group B there were no significant changes at both sites. At the end of the study 12 new vertebral fractures had occurred in 10 patients of group A and 21 in 17 patients of group B (new fractures per 100 patient years 10.2 versus 18.1). In accordance with the observed fracture rates the alfacalcidol group showed a significant decrease in back pain whereas no change was registered in the vitamin D group. We conclude that with the doses used in this trial alfacalcidol is superior to vitamin D in the treatment of established CIOP. le

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