Abstract
OBJECTIVE: To compare the long term effects of low dosage prednisolone or deflazacort treatments on bone mass in patients with polymyalgia rheumatica. METHODS: Thirty patients with polymyalgia rheumatica were allocated on a random double blind basis to receive treatment with prednisolone or deflazacort. Bone mineral content (BMC) was measured in the lumbar spine and in the distal forearm before treatment and three, six, and 12 months after treatment. RESULTS: At three months the decrease in lumbar BMC and bone mineral density (BMD) was significantly greater in the deflazacort group than in the prednisolone group (p < 0.05), but at six and 12 months there was no difference between the two groups. In all patients after one year there was a significant loss of BMC: a 6.4% loss in lumbar BMC and a 1.8% loss in distal forearm BMC. Loss in lumbar BMC after six months was correlated to the cumulative dose of corticosteroid (r = 0.4; p < 0.05) and was significantly greater in the group of patients who had persisting symptoms of polymyalgia at six weeks, three months, or both, after treatment started (p = 0.05). CONCLUSION: This low dose study failed to reveal any calcium sparing properties of deflazacort compared with prednisolone. Possible explanations for this finding are discussed.
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- Adinoff A. D., Hollister J. R. Steroid-induced fractures and bone loss in patients with asthma. N Engl J Med. 1983 Aug 4;309(5):265–268. doi: 10.1056/NEJM198308043090502. [DOI] [PubMed] [Google Scholar]
- Bird H. A., Esselinckx W., Dixon A. S., Mowat A. G., Wood P. H. An evaluation of criteria for polymyalgia rheumatica. Ann Rheum Dis. 1979 Oct;38(5):434–439. doi: 10.1136/ard.38.5.434. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dykman T. R., Gluck O. S., Murphy W. A., Hahn T. J., Hahn B. H. Evaluation of factors associated with glucocorticoid-induced osteopenia in patients with rheumatic diseases. Arthritis Rheum. 1985 Apr;28(4):361–368. doi: 10.1002/art.1780280402. [DOI] [PubMed] [Google Scholar]
- Gennari C., Imbimbo B. Effects of prednisone and deflazacort on vertebral bone mass. Calcif Tissue Int. 1985 Dec;37(6):592–593. doi: 10.1007/BF02554912. [DOI] [PubMed] [Google Scholar]
- Gray R. E., Doherty S. M., Galloway J., Coulton L., de Broe M., Kanis J. A. A double-blind study of deflazacort and prednisone in patients with chronic inflammatory disorders. Arthritis Rheum. 1991 Mar;34(3):287–295. doi: 10.1002/art.1780340306. [DOI] [PubMed] [Google Scholar]
- Krølner B., Toft B. Vertebral bone loss: an unheeded side effect of therapeutic bed rest. Clin Sci (Lond) 1983 May;64(5):537–540. doi: 10.1042/cs0640537. [DOI] [PubMed] [Google Scholar]
- Lund B., Egsmose C., Jørgensen S., Krogsgaard M. R. Establishment of the relative antiinflammatory potency of deflazacort and prednisone in polymyalgia rheumatica. Calcif Tissue Int. 1987 Dec;41(6):316–320. doi: 10.1007/BF02556669. [DOI] [PubMed] [Google Scholar]
- Messina O. D., Barreira J. C., Zanchetta J. R., Maldonado-Cocco J. A., Bogado C. E., Sebastián O. N., Flores D., Riopedre A. M., Redondo G., Lázaro A. Effect of low doses of deflazacort vs prednisone on bone mineral content in premenopausal rheumatoid arthritis. J Rheumatol. 1992 Oct;19(10):1520–1526. [PubMed] [Google Scholar]
- Olgaard K., Storm T., van Wowern N., Daugaard H., Egfjord M., Lewin E., Brandi L. Glucocorticoid-induced osteoporosis in the lumbar spine, forearm, and mandible of nephrotic patients: a double-blind study on the high-dose, long-term effects of prednisone versus deflazacort. Calcif Tissue Int. 1992 Jun;50(6):490–497. doi: 10.1007/BF00582160. [DOI] [PubMed] [Google Scholar]
- Pacifici R., Susman N., Carr P. L., Birge S. J., Avioli L. V. Single and dual energy tomographic analysis of spinal trabecular bone: a comparative study in normal and osteoporotic women. J Clin Endocrinol Metab. 1987 Feb;64(2):209–214. doi: 10.1210/jcem-64-2-209. [DOI] [PubMed] [Google Scholar]
- Reid D. M., Kennedy N. S., Smith M. A., Nicoll J., Brown N., Tothill P., Nuki G. Bone loss in rheumatoid arthritis and primary generalized osteoarthrosis: effects of corticosteroids, suppressive antirheumatic drugs and calcium supplements. Br J Rheumatol. 1986 Aug;25(3):253–259. doi: 10.1093/rheumatology/25.3.253. [DOI] [PubMed] [Google Scholar]
- Sambrook P. N., Eisman J. A., Champion G. D., Yeates M. G., Pocock N. A., Eberl S. Determinants of axial bone loss in rheumatoid arthritis. Arthritis Rheum. 1987 Jul;30(7):721–728. doi: 10.1002/art.1780300701. [DOI] [PubMed] [Google Scholar]
- Sambrook P. N., Eisman J. A., Yeates M. G., Pocock N. A., Eberl S., Champion G. D. Osteoporosis in rheumatoid arthritis: safety of low dose corticosteroids. Ann Rheum Dis. 1986 Nov;45(11):950–953. doi: 10.1136/ard.45.11.950. [DOI] [PMC free article] [PubMed] [Google Scholar]