Long-term effect of 1 alpha-hydroxyvitamin D, calcium and thiazide administration on glucocorticoid-induced osteoporosis

25Citations
Citations of this article
23Readers
Mendeley users who have this article in their library.

Abstract

Thirty-eight patients with collagen diseases undergoing chronic glucocorticoid treatment were studied to assess the effect of a 24 month administration of oral 1 alpha-hydroxyvitamin D (1 alpha-OHD), calcium and thiazide on bone and mineral metabolism. All patients were premenopausal women (mean age = 35 y.o.) and had been treated with prednisolone (mean dose = 11 mg/day). Patients were randomly divided into three groups. Fourteen patients were treated with 0.75 micrograms of 1 alpha-OHD and 400 mg of calcium daily (1 alpha-OHD group). Eleven patients were treated with 1 alpha-OHD, calcium and 4 mg of trichlormethiazide (thiazide group). Thirteen patients did not have any treatment for osteoporosis and served as a patient control group. There were no significant differences in age, underlying disease, dose of glucocorticoid, or pretreatment values of indices of osteoporosis among the three groups. Twenty-four hour urinary calcium excretion had increased above 300 mg/g creatinine at 12 or 24 months after the start of the treatment in 9 patients of the 1 alpha-OHD group, and asymptomatic renal stones developed in 2 of them. However, neither hypercalciuria nor renal stones developed in the thiazide group or the control group. Serum iPTH levels were suppressed significantly in the thiazide group, but did not change in the 1 alpha-OHD group or the control group. Metacarpal index (MCI) and sigma GS/D, indices of microdensitometry method which indicate bone mineral content, had significantly increased after 12 and 24 months in the thiazide group, while these indices did not change significantly in the 1 alpha-OHD group and deteriorated in the control group at 24 months. Seven patients of the control group and 4 of the 1 alpha-OHD group showed deteriorations in Singh's grade compared to only 2 in the thiazide group. Vertebral bone fractures developed in 5 vertebras of the 2 patients in the control group and 4 of the 3 patients in the 1 alpha-OHD group during the 24 months. But none of the thiazide group suffered from bone fractures. It may be concluded that combination therapy with 1 alpha-OHD, calcium and thiazide is effective in the prevention of glucocorticoid-induced osteoporosis. Long-term administration of 1 alpha-OHD and calcium should be avoided in patients undergoing chronic glucocorticoid therapy because of the risk of the development of nephrolithiasis.

Cite

CITATION STYLE

APA

Yamada, H. (1989). Long-term effect of 1 alpha-hydroxyvitamin D, calcium and thiazide administration on glucocorticoid-induced osteoporosis. Nippon Naibunpi Gakkai Zasshi, 65(6), 603–614. https://doi.org/10.1507/endocrine1927.65.6_603

Register to see more suggestions

Mendeley helps you to discover research relevant for your work.

Already have an account?

Save time finding and organizing research with Mendeley

Sign up for free