Pulsed Corticosteroids Tied to Notable Bone Loss

August 4, 2004

NEW YORK (Reuters Health) Jul 30 - Intravenous therapy with pulsed

methylprednisolone for rheumatic disorders appears to be associated with

considerable reduction in bone mineral density, UK researchers report in the

August issue of the ls of the Rheumatic Diseases.

Dr. Emery of Leeds General Infirmary and colleagues note it is commonly

held that short term pulsed methylprednisolone does not lead to long term

bone mineral density (BMD) changes.

To investigate further, the researchers studied 38 patients, of whom 30 were

women. All had rheumatic disorders such as rheumatoid arthritis, systemic

sclerosis and lupus and were undergoing methylprednisolone pulsed therapy.

The subjects received a mean cumulative dose of 3.0 g of methylprednisolone,

given as 5.7 pulses over a median of 5.7 months.

Most (34 patients) were also pulsed with cyclophosphamide, 20 were taking

oral corticosteroids and 8 were using estrogen or bisphosphonates.

At follow-up, the researchers found that BMD was reduced by a mean of 2.2%

at the femoral neck, 1.1% at the total hip, and 1.0% at the spine.

In patients not receiving antiresorptive treatment, such as estrogen or

bisphosphonates, and taking oral corticosteroids, the corresponding BMD

reductions were 4.4%, 2.4% and 2.1%. In patients not taking oral

corticosteroids, they amounted to 1.7%, 1.9% and 2.6%.

However, in patients taking in estrogen or bisphosphonates, there were BMD

increases of 1.6%, 3.2% and 4.5%.

In light of the high rate of bone loss, the researchers suggest that

prevention with ssphosphonates and estrogen should be considered.

" This is especially important, " they conclude, " in patients with low BMD,

high disease activity, and other risk factors for osteoporosis. "

Ann Rheum Dis 2004;63:940-944.

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