Drs Eisman and Sambrook have served as consultants for Eli Lilly & Co. and Merck & Co. Dr Eisman has served as a consultant for Mission Pharmacal. All other authors have no conflict of interest.
Prevention and Treatment of Glucocorticoid-Induced Osteoporosis: A Comparison of Calcitriol, Vitamin D Plus Calcium, and Alendronate Plus Calcium
Article first published online: 1 MAY 2003
Copyright © 2003 ASBMR
Journal of Bone and Mineral Research
Volume 18, Issue 5, pages 919–924, May 2003
How to Cite
Sambrook, P. N., Kotowicz, M., Nash, P., Styles, C. B., Naganathan, V., Henderson-Briffa, K. N., Eisman, J. A. and Nicholson, G. C. (2003), Prevention and Treatment of Glucocorticoid-Induced Osteoporosis: A Comparison of Calcitriol, Vitamin D Plus Calcium, and Alendronate Plus Calcium. J Bone Miner Res, 18: 919–924. doi: 10.1359/jbmr.2003.18.5.919
- Issue published online: 2 DEC 2009
- Article first published online: 1 MAY 2003
- Manuscript Accepted: 26 NOV 2002
- Manuscript Revised: 7 NOV 2002
- Manuscript Received: 30 MAY 2002
- bone density;
- vitamin D;
High-dose corticosteroids, used for many medical conditions, are associated with rapid bone loss from sites such as the vertebrae, and compression fractures can be observed within months. Recent trials suggest treatment with bisphosphonates or active vitamin D analogs can reduce bone loss and the risk of fracture associated with glucocorticoids, but few studies have directly compared such agents. We conducted a randomized, multicenter, open-label trial to compare the efficacy of alendronate, calcitriol, and simple vitamin D in prevention and treatment of glucocorticoid-induced bone loss. A total of 195 subjects (134 females and 61 males) commencing or already taking glucocorticoids were randomized to one of three groups: calcitriol, 0.5 to 0.75 μg/day; simple vitamin D (ergocalciferol, 30,000 IU weekly) plus calcium carbonate (600 mg daily); or alendronate, 10 mg/day plus calcium carbonate (600 mg daily). Over 2 years, mean lumbar bone mineral density change was +5.9% with alendronate, −0.5% with ergocalciferol, and −0.7% with calcitriol (p < 0.001). At the femoral neck, there was no significant difference in bone mineral density change between the treatments over 2 years: alendronate (+0.9%), ergocalciferol (−3.2%), and calcitriol (−2.2%). Lumbar bone loss varied according to whether patients were starting or receiving chronic glucocorticoids, and there was a significant treatment × prior glucocorticoid use interaction effect. Six of 66 calcitriol subjects, 1 of 61 ergocalciferol subjects, and 0 of 64 alendronate subjects sustained new vertebral fractures. These data do not suggest any difference between simple vitamin D and calcitriol but do show that alendronate was superior to either treatment for glucocorticoid induced bone loss.