BONE MINERAL DENSITY (BMD) EVALUATION IN PATIENTS WITH LONG-TERM GLUCOCORTICOID THERAPY: EFFECT OF ORAL CALCIUM AND VITAMIN-D

Abstract

Excess glucocorticoids induce osteoporosis. The effect of calcium and vitamin D on its prevention is uncertain. To clarify this issue we studied 2 groups of patients: group 1 (G1), n=8, who received methylprednisone (MP), vitamin D (ergocalciferol) 2900 ± 1700 U/day* and calcium 1.0±0.5 gr/day* for 3.65±3.74 years* (r: 0.4-9 years); group 2 (G2) n=15, patients received MP alone for 3.78±2.46 years* (r:0.5 to + 10 years). BMD of radius shaft (RS) and lumbar spine (LS) (L2-L4) was determinated by single and dual photon absorptiometry. Compared with normal controls,a significant reduction in BMD was observed in the RS of G2, 2 score was -0.8± 1.02*, p < 0.01 and in LS of both groups, G1:-1.86+2.56*, p<0.05; G2:-2.0±1.67*, p < 0.0005. A negative correlation was found both in G1 and G2 between BMD (Z score) of RS and LS, and the duration of treatment. Furthermore, during the first 3 years of treatment, only G2 showed a significant decrease of LS BMD; when treatment lasted more than 4 years, G1 also showed a reduction of RS and LS BMD. Long-term glucocorticoid therapy induces bone demineralization, principally affecting trabecular bone. This could be prevented by adding calcium and vitamin D but benefits occur only during the firBt 3 years of treatment.