The role of vitamin D in corticosteroid-induced osteoporosis: A meta-analytic approach
Article first published online: 26 APR 2001
Copyright © 1999 by the American College of Rheumatology
Arthritis & Rheumatism
Volume 42, Issue 8, pages 1740–1751, August 1999
How to Cite
Amin, S., LaValley, M. P., Simms, R. W. and Felson, D. T. (1999), The role of vitamin D in corticosteroid-induced osteoporosis: A meta-analytic approach. Arthritis & Rheumatism, 42: 1740–1751. doi: 10.1002/1529-0131(199908)42:8<1740::AID-ANR25>3.0.CO;2-E
- Issue published online: 26 APR 2001
- Article first published online: 26 APR 2001
- Manuscript Accepted: 23 MAR 1999
- Manuscript Received: 26 OCT 1998
- NIH. Grant Number: AR-20613
- Arthritis Foundation
- Merck Frosst Canada Inc
To determine if vitamin D is more effective than no therapy or calcium alone in the management of corticosteroid-induced osteoporosis, and to determine how vitamin D compares with other osteoporosis therapies, e.g., bisphosphonates, calcitonin, or fluoride, for this condition.
We evaluated all formulations of vitamin D, including its active metabolites and analogs. A systematic search for published and unpublished studies was conducted using MEDLINE (1966–December 1997), bibliographic references, abstracts from proceedings of recent national meetings, and contact with pharmaceutical companies and content experts. We included all randomized controlled trials lasting at least 6 months (and reporting extractable results), of patients receiving oral corticosteroids, that compared vitamin D with either 1) no therapy or calcium alone, or 2) bisphosphonates, calcitonin, or fluoride. The primary outcome measure of interest was change in lumbar spine bone mineral density.
We found a moderate beneficial effect of vitamin D plus calcium versus no therapy or calcium alone (9 trials) (effect size 0.60; 95% confidence interval [95% CI] 0.34, 0.85; P < 0.0001). In comparisons of vitamin D with other osteoporosis therapies, bisphosphonates were more effective than vitamin D (6 trials) (effect size 0.57; 95% CI 0.09, 1.05). Calcitonin was similar in efficacy to vitamin D (4 trials) (effect size 0.03; 95% CI −0.39, 0.45). Fluoride was more effective than vitamin D, but there were only 2 trials.
Vitamin D plus calcium is superior to no therapy or calcium alone in the management of corticosteroid-induced osteoporosis. Vitamin D is less effective than some osteoporosis therapies. Therefore, treatment with vitamin D plus calcium, as a minimum, should be recommended to patients receiving long-term corticosteroids.