Effect of calcitriol and calcium supplementation in the prevention of glucocorticoid -induced osteoporosis among systemic lupus erythematosus patients
Loading...
Date
2001-05
Authors
Chan, Lee Chin
Journal Title
Journal ISSN
Volume Title
Publisher
Universiti Sains Malaysia
Abstract
Prolonged glucocorticoid therapy can lead to loss of bone mineral density (BMD) and
higher risk of fracture. Fortunately this can be prevented or reduced if preventive
measures are started early. Calcitriol (1 ,25-dihydroxyvitamin D3) and calcium
supplementation is a rational therapy for minimising bone loss but has not been widely
used locally. Our primary objective was to study the effect of calcitriol and calcium carbonate
supplementation in the prevention of glucocorticoid-induced osteoporosis in our local
systemic lupus erythematosus (SLE) patients. Our secondary objectives were to identify
factors, which influenced the rate of bone loss in our SLE patients and also to see the
effect of calcitriol and calcium carbonate on glucocorticoid-induced bone loss in the
subgroup of patients with normal or reduced baseline BMD Sixty-nine SLE patients who were on long term glucocorticoid therapy were randomly
assigned to receive either oral calcitriol 0.25 ).lg BD or calcium carbonate 1.25 gm BD
for one year. BMD was measured every six months for a year by the same dual X-ray
absorptiometry (DXA). There were no significant differences between groups at entry
with respect to demographics and risk factors for osteoporosis. Analysis was done to see
the effect of supplementation on the BMD of the spine and femur. Further sub-analysis was made to see the effect of supplementation on BMD of patients with normal bone
density or osteopenia at entry. Calcitriol was more effective than calcium in preventing bone loss from the spine. Mean
percentage change at 6 month for calcitriol and calcium were 2.16% and -0.55 %
(p=0.05) respectively. While mean of change of BMD at one year for calcitriol and
calcium were 0.52% and -0.32% respectively. Calcitriol also prevent bone loss from the
femur in the first 6 months of the study (mean percentage change of 0.63o/o) but to a
lesser degree than that in the spine. Calcium was unable to provide any protection
against bone loss in the spine or femur. Those patients with osteopenic at baseline benefited most from calcitriol and calcium
supplementation. When given calcitriol, their mean percentage increase in BMD of the
spine were 3.62% at 6 month and 1.68% at one year. Those on calcium also showed an
increase in BMD of 0. 77% and 1.66% respectively.
Patients with normal baseline bone density showed an improvement only at the spine at
6 month (percentage increase of 1.12%) when given calcitriol supplementation. Calcitriol supplementation was more effective in preventing glucocorticoid-induced
bone loss than calcium supplementation. Calcitriol with calcium supplementation
offered protection against glucocorticoid-induced bone loss if given to patients who
were osteopenia.
Description
Keywords
Calcitriol and calcium carbonate