Corticosteroids are widely used to treat inflammation. Bone loss (osteoporosis) is a serious side effect of this therapy. We reviewed a total of 5 trials which included 742 patients. We found that after two years of treatment, the bone mineral density of the lumbar spine and forearm of patients taking calcium and vitamin D therapy improved more than patients who had no treatment. There was no difference in the number of fractures or laboratory measures of bone density between the two groups. We found that calcium and vitamin D is effective at preventing and treating corticosteroid-induced bone loss at the lumbar spine and forearm. The treatment appears to be safe.
This meta-analysis demonstrated a clinically and statistically significant prevention of bone loss at the lumbar spine and forearm with vitamin D and calcium in corticosteroid treated patients. Because of low toxicity and cost all patients being started on corticosteroids should receive prophylactic therapy with calcium and vitamin D.
Osteoporosis and subsequent fracture are a major cause of morbidity and mortality. It is defined by low bone mass, and has many etiologies with different patterns of bone loss. Corticosteroid therapy is a contributor to the development of osteoporosis. Steroids cause bone loss by a variety of complex mechanisms. It has been suggested that patients initiating steroids should receive preventative therapy (calcium, Vitamin D, estrogens or bisphosphonates).
To assess the effects of calcium and vitamin D compared to calcium alone or placebo in the prevention of bone loss in patients taking systemic corticosteroids.
We searched the Cochrane Musculoskeletal trials register, Cochrane Controlled Trials Register, EMBASE and MEDLINE up to 1996. We also conducted a hand search of abstracts from various scientific meetings and reference lists of selected trials.
All randomized trials comparing calcium and vitamin D to calcium alone or placebo in patients taking systemic corticosteroids.
Data was abstracted from trials by two investigators. Methodological quality was assessed in a similar manner. Analysis was performed using fixed effects models.
Five trials were included, with 274 patients. The analysis was performed at two years after starting calcium and vitamin D. There was a significant weighted mean difference (WMD) between treatment and control groups in lumbar (WMD 2.6 (95% CI 0.7, 4.5), and radial bone mineral density (WMD 2.5 (95%CI 0.6, 4.4). The other outcome measures (femoral neck bone mass, fracture incidence, biochemical markers of bone resorption) were not significantly different.