Calcium and vitamin D for corticosteroid-induced osteoporosis

  • Review
  • Intervention

Authors


Abstract

Background

Osteoporosis and subsequent fracture are a major cause of morbidity and mortality. It is defined by low bone mass, and has many etiologies with different patterns of bone loss. Corticosteroid therapy is a contributor to the development of osteoporosis. Steroids cause bone loss by a variety of complex mechanisms. It has been suggested that patients initiating steroids should receive preventative therapy (calcium, Vitamin D, estrogens or bisphosphonates).

Objectives

To assess the effects of calcium and vitamin D compared to calcium alone or placebo in the prevention of bone loss in patients taking systemic corticosteroids.

Search methods

We searched the Cochrane Musculoskeletal trials register, Cochrane Controlled Trials Register, EMBASE and MEDLINE up to 1996. We also conducted a hand search of abstracts from various scientific meetings and reference lists of selected trials.

Selection criteria

All randomized trials comparing calcium and vitamin D to calcium alone or placebo in patients taking systemic corticosteroids.

Data collection and analysis

Data was abstracted from trials by two investigators. Methodological quality was assessed in a similar manner. Analysis was performed using fixed effects models.

Main results

Five trials were included, with 274 patients. The analysis was performed at two years after starting calcium and vitamin D. There was a significant weighted mean difference (WMD) between treatment and control groups in lumbar (WMD 2.6 (95% CI 0.7, 4.5), and radial bone mineral density (WMD 2.5 (95%CI 0.6, 4.4). The other outcome measures (femoral neck bone mass, fracture incidence, biochemical markers of bone resorption) were not significantly different.

Authors' conclusions

This meta-analysis demonstrated a clinically and statistically significant prevention of bone loss at the lumbar spine and forearm with vitamin D and calcium in corticosteroid treated patients. Because of low toxicity and cost all patients being started on corticosteroids should receive prophylactic therapy with calcium and vitamin D.

摘要

背景

鈣質及維他命D減少類固醇使用引起的骨質疏鬆症

類固醇的使用可能造成骨質疏鬆症,以及後續骨折引起併發症及死亡,一般建議開始使用類固醇的患者應服用鈣質、維他命、雌性激素或雙磷酸鹽類藥物(calcium, Vitamin D, estrogens or bisphosphonates)做預防治療。

目標

比較補充鈣質及維他命D與只服用鈣質或安慰劑,預防類固醇使用引起的骨質流失效果。

搜尋策略

搜尋包括Cochrane Musculoskeletal trials register, Cochrane Controlled Trials Register, EMBASE and MEDLINE (直到1999年),同時手動搜尋會議摘要及所選文章之參考文獻。

選擇標準

所有比較補充鈣質及維他命D與只服用鈣質或安慰劑預防類固醇使用引起的骨質流失效果的隨機對照試驗。

資料收集與分析

2個評論者分別評估試驗品質跟擷取數據,並使用固定效果模式分析。

主要結論

5篇研究符合選入條件(274例病患)。使用鈣質及維他命D兩年後做評估分析。補充鈣質及維他命D與安慰劑組在腰椎脊橈骨質密度 之加權平均差異(weighted mean difference, WMD)有顯著差異 [lumbar, WMD 2.6 (95% CI 0.7 – 4.5); radial bone, WMD 2.5 (95% CI 0.6 – 4.4)],其它指標(股骨頸骨密度,骨折發生率,骨質再吸收的生物標記)並無顯著差異。

作者結論

研究顯示,補充鈣質及維他命D於使用類固醇患者,統計上顯著減少在腰椎與橈骨骨質流失。因毒性及價格低,所有使用類固醇患者均應使用鈣質及維他命D預防治療。

翻譯人

本摘要由林口長庚醫院余光輝翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

無總結

Plain language summary

Calcium and vitamin D for treating osteoporosis caused by the use of steroids

Corticosteroids are widely used to treat inflammation. Bone loss (osteoporosis) is a serious side effect of this therapy. We reviewed a total of 5 trials which included 742 patients. We found that after two years of treatment, the bone mineral density of the lumbar spine and forearm of patients taking calcium and vitamin D therapy improved more than patients who had no treatment. There was no difference in the number of fractures or laboratory measures of bone density between the two groups. We found that calcium and vitamin D is effective at preventing and treating corticosteroid-induced bone loss at the lumbar spine and forearm. The treatment appears to be safe.

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