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NEW YORK (Reuters Health) Dec 26 - Among premenopausal women taking corticosteroids for systemic lupus erythematosus, various treatments preserve bone mineral density and "should be considered for osteoporosis prophylaxis," according to a report in the December issue of the Journal of Rheumatology.
"Whether due to the corticosteroid treatment, or to the disease itself, osteoporosis is being increasingly recognized in patients with SLE and is an important cause of comorbidity," write Dr. Swan S. Yeap, of the University of Malaya, Kuala Lumpur, and colleagues.
In a prospective, randomized controlled study, the researchers assessed changes in bone mineral density (BMD) in 98 premenopausal women with SLE undergoing long-term corticosteroid therapy while taking calcium carbonate 500 mg twice daily (calcium alone), calcitriol 0.25 mcg twice daily plus calcium carbonate 500 mg twice daily (calcitriol + calcium), or alendronate 70 mg once a week plus calcium carbonate 500 mg twice daily (alendronate + calcium).
Of the 98 patients, 77 (78.6%) completed the 2-year study, including 23 taking calcium alone, 27 taking calcitriol + calcium, and 27 taking alendronate + calcium.
In the alendronate + calcium group, there were significant increases in BMD at both the lumbar spine (2.69%) and total hip (1.41%) compared to baseline. There were no significant changes found in the calcium-alone and the calcitriol + calcium groups, except for a 0.93% reduction in total hip BMD in the calcium-alone group.
The medications were well tolerated. There were few adverse effects that required additional drug therapy or withdrawal of treatment. "Four patients had 5 isolated episodes of hypercalcemia during the course of the 2 years, all of whom were in the calcitriol + calcium group," Dr. Yeap's team notes. "The hypercalcemia resolved by the following visit with no need for dose adjustment."
In this cohort of premenopausal women taking corticosteroids for SLE, the researchers conclude, bone mineral density can be preserved or increased with prophylactic therapy.
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