RESEARCH - A comparison of calcium, calcitriol, and alendronate in steroid-treated premenopausal patients with SLE

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J Rheumatol. 2008 Nov 1. [Epub ahead of print]

A Comparison of Calcium, Calcitriol, and Alendronate in

Corticosteroid-Treated Premenopausal Patients with Systemic Lupus

Erythematosus.

Yeap SS, Fauzi AR, Kong NC, Halim AG, Soehardy Z, Rahimah I, Chow SK, Goh EM.

From the Department of Medicine, Faculty of Medicine, University of

Malaya, Kuala Lumpur; and Department of Medicine, Hospital University

Kebangsaan Malaysia, University

Kebangsaan Malaysia, Kuala Lumpur, Malaysia.

OBJECTIVE: To assess bone mineral density (BMD) changes in patients

with systemic lupus erythematosus (SLE) undergoing longterm therapy

with corticosteroids (CS) while taking calcium, calcitriol, or

alendronate. The primary endpoint was BMD changes at 2 years.

METHODS: Premenopausal SLE patients were randomized into 3 groups

according to medication: calcium carbonate 500 mg bd (calcium alone),

calcitriol 0.25 microg bd plus calcium carbonate 500 mg bd (calcitriol

+ calcium), and alendronate 70 mg/week plus calcium carbonate 500 mg

bd (alendronate + calcium). BMD was measured at baseline and at the

end of the first and second years.

RESULTS: Ninety-eight patients were recruited. There were 33 patients

taking calcium alone, 33 calcitriol + calcium, and 32 alendronate +

calcium. On randomization, median duration of CS use was 2.5 years

(range 0-20 yrs). Seventy-seven patients (78.6%) completed the study

(23 taking calcium alone, 27 calcitriol + calcium, 27 alendronate +

calcium). There were no significant differences in mean CS dosages

among the 3 groups at the time of BMD measurements. After 2 years,

there were no significant changes in BMD in the calcium-alone and

calcitriol + calcium groups, apart from a 0.93% (p < 0.001) reduction

in total hip BMD in the calcium-alone group. In contrast, the

alendronate + calcium group showed significant increases in BMD of

2.69% (p < 0.001) in the lumbar spine and 1.41% (p < 0.001) in total

hip.

CONCLUSION: Both calcium alone and calcitriol + calcium preserved

lumbar spine BMD in premenopausal patients with SLE taking longterm CS

at 2 years, whereas alendronate + calcium led to increases in BMD in

lumbar spine and total hip. Premenopausal women taking CS should be

considered for osteoporosis prophylaxis.

PMID: 19004038

http://www.ncbi.nlm.nih.gov/pubmed/19004038

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