Skip to main content
NCBI home page
Thorax logoLink to Thorax
. 1998 May;53(5):351–356. doi: 10.1136/thx.53.5.351

A double blind placebo controlled study to determine the effects of intermittent cyclical etidronate on bone mineral density in patients on long term oral corticosteroid treatment

P Pitt 1, F Li 1, P Todd 1, D Webber 1, S Pack 1, C Moniz 1
PMCID: PMC1745232  PMID: 9708225

Abstract

BACKGROUND—A double blind, placebo controlled study was undertaken to determine the effects of 104 weeks of intermittent cyclical etidronate therapy on bone mineral density (BMD) in patients undergoing long term oral corticosteroid therapy.
METHODS—Forty nine patients of mean age 59 years on long term (>6 months) corticosteroid treatment were randomised to receive either 400 mg/day etidronate or placebo for 14 days followed in both groups by calcium (equivalent to 97 mg elemental Ca/day) with vitamin D (400 IU) for 76 days. The cycle was repeated a total of eight times over a period of two years. Dual energy x ray absorptiometry (DEXA) measurements of the lumbar spine and hip BMD and biochemical bone marker analyses were performed at baseline and every six months.
RESULTS—Twenty six patients (10 men) received cyclical etidronate and 23 (nine men) received placebo. The mean (SD) dose of corticosteroid (prednisone or equivalent) at baseline in the etidronate group was 8 (4) mg/day and in the placebo group was 7 (4) mg/day. Most of the patients (43%) suffered from asthma. Forty one patients completed the study (22 in the etidronate group and 19 in the placebo group). All had a low BMD at entry and with treatment a significant difference was observed between groups in the mean (SE) percentage change from baseline in lumbar spine BMD at week 104 of 4.5 (1.65)% (p = 0.007) with a 95% confidence interval (CI) of 1.12 to 7.87%. No clinically or statistically significant treatment differences were observed at the hip or with bone markers. The incidence of adverse events was similar in the two groups.
CONCLUSIONS—The results show that intermittent cyclical etidronate therapy with calcium and vitamin D supplementation significantly increases lumbar spine BMD in patients with osteoporosis resulting from long term treatment with corticosteroids.



Full Text

The Full Text of this article is available as a PDF (111.0 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adachi J., Cranney A., Goldsmith C. H., Bensen W. G., Bianchi F., Cividino A., Craig G. L., Kaminska E., Sebaldt R. J., Papaioannou A. Intermittent cyclic therapy with etidronate in the prevention of corticosteroid induced bone loss. J Rheumatol. 1994 Oct;21(10):1922–1926. [PubMed] [Google Scholar]
  2. 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]
  3. Compston J. E., Judd D., Crawley E. O., Evans W. D., Evans C., Church H. A., Reid E. M., Rhodes J. Osteoporosis in patients with inflammatory bowel disease. Gut. 1987 Apr;28(4):410–415. doi: 10.1136/gut.28.4.410. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Dempster D. W. Bone histomorphometry in glucocorticoid-induced osteoporosis. J Bone Miner Res. 1989 Apr;4(2):137–141. doi: 10.1002/jbmr.5650040202. [DOI] [PubMed] [Google Scholar]
  5. Genant H. K., Wu C. Y., van Kuijk C., Nevitt M. C. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. 1993 Sep;8(9):1137–1148. doi: 10.1002/jbmr.5650080915. [DOI] [PubMed] [Google Scholar]
  6. Kanis J. A. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO Study Group. Osteoporos Int. 1994 Nov;4(6):368–381. doi: 10.1007/BF01622200. [DOI] [PubMed] [Google Scholar]
  7. Li F., Pitt P. I., Sherwood R., Barrett J., Houghton J., Parsons V., Moniz C. Biochemical markers of bone turnover in women with surgically treated carcinoma of the breast. Eur J Clin Invest. 1993 Sep;23(9):566–571. doi: 10.1111/j.1365-2362.1993.tb00967.x. [DOI] [PubMed] [Google Scholar]
  8. Lukert B. P., Raisz L. G. Glucocorticoid-induced osteoporosis. Rheum Dis Clin North Am. 1994 Aug;20(3):629–650. [PubMed] [Google Scholar]
  9. Lukert B. P., Raisz L. G. Glucocorticoid-induced osteoporosis: pathogenesis and management. Ann Intern Med. 1990 Mar 1;112(5):352–364. doi: 10.7326/0003-4819-112-5-352. [DOI] [PubMed] [Google Scholar]
  10. Pitt P., Compston J., Trivedi P., Salisbury J., Berry H., Moniz C., Parsons V. Systemic bone changes accompanying early rheumatoid arthritis in patients treated with nonsteroidal antiinflammatory drugs alone. Clin Orthop Relat Res. 1994 Jan;(298):250–258. [PubMed] [Google Scholar]
  11. Reid I. R., King A. R., Alexander C. J., Ibbertson H. K. Prevention of steroid-induced osteoporosis with (3-amino-1-hydroxypropylidene)-1,1-bisphosphonate (APD). Lancet. 1988 Jan 23;1(8578):143–146. doi: 10.1016/s0140-6736(88)92721-3. [DOI] [PubMed] [Google Scholar]
  12. Sambrook P., Birmingham J., Kelly P., Kempler S., Nguyen T., Pocock N., Eisman J. Prevention of corticosteroid osteoporosis. A comparison of calcium, calcitriol, and calcitonin. N Engl J Med. 1993 Jun 17;328(24):1747–1752. doi: 10.1056/NEJM199306173282404. [DOI] [PubMed] [Google Scholar]
  13. Schaadt O., Bohr H. Bone mineral in lumbar spine, femoral neck and femoral shaft measured by dual photon absorptiometry with 153-gadolineum in prednisone treatment. Adv Exp Med Biol. 1984;171:201–208. [PubMed] [Google Scholar]
  14. Sebaldt R. J., Adachi J. D., Bensen W. G., Bianchi F., Cividano A., Craig G. L., Cranney A., Kaminska E., Gordon M., Steele M. Intermittent cyclic therapy with etidronate prevents corticosteroid-induced bone loss: two years of follow-up. Scand J Rheumatol Suppl. 1996;103:91–93. doi: 10.3109/03009749609103760. [DOI] [PubMed] [Google Scholar]
  15. Struys A., Snelder A. A., Mulder H. Cyclical etidronate reverses bone loss of the spine and proximal femur in patients with established corticosteroid-induced osteoporosis. Am J Med. 1995 Sep;99(3):235–242. doi: 10.1016/s0002-9343(99)80154-5. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES