S21_9

Calcium and vitamin D in the prevention and treatment of glucocorticoid-induced osteoporosis

J.D. Ringe, H. Faber

Medizinische Klinik 4, Klinikum Leverkusen, (University of Cologne), Leverkusen, Germany.

ABSTRACT
Although there are today a wide range of effective drugs to counteract the deleterious effects of glucocorticoids (GC) on bone, less than 10% of patients on long-term GC therapy receive simultaneously adequate osteoprotective treatment. Before beginning a course of long-term GC therapy, the appropriate strategy of anti-osteoporotic treatment should be determined for the individual patient, based on the initial bone mineral density, underlying disease, requested GC dosage, history of back pain and/or fractures, and age and sex.
Supplementation with 500-1000 mg calcium alone is not sufficient to stop bone loss in these patients. Vitamin D plus calcium may moderately reduce bone loss during GC therapy, especially in the first year, and in vitamin D depleted patients. Furthermore, this combination may be useful as a basic treatment to be combined with specific drugs (e.g., HRT, SERMs, fluoride, calcitonin, or bisphosphonates). The active metabolites calcitriol and alfacalcidol are effective in both the prevention and treatment of glucocorticoid-induced osteoporosis.

Key words
Glucocorticoid-induced osteoporosis, calcium, plain vitamin D, calcitriol, alfacalcidol.

Please address correspondence and reprint requests to: Prof.Dr. J.D. Ringe, Medizinische Klinik 4, Klinikum Leverkusen, (University of Cologne), D-51375 Leverkusen, Germany.