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Calcium and vitamin D for corticosteroid-induced osteoporosis
J Homik1, M E Suarez-Almazor, B Shea
1Medicine, 562 Heritage Medical Research Centre, University Of Alberta, Edmonton, Alberta, Canada, T6G 2S2. jhomik@gpu.srv.ualberta.ca
Objectives:
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.
Search Strategy:
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.
Selection Criteria:
All randomized trials comparing calcium and vitamin D to calcium alone or placebo in patients taking systemic corticosteroids.
Data Collection And Analysis:
Data was abstracted from trials by two investigators. Methodological quality was assessed in a similar manner. Analysis was performed using fixed effects models.
Main Results:
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.
Reviewer'S Conclusions:
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.