Cyclical etidronate increases bone density in the spine and hip of postmenopausal women receiving long term corticosteroid treatment. A double blind, randomised placebo controlled study

Abstract

Objective: To study the effect of cyclic etidronate in secondary prevention of corticosteroid induced osteoporosis.

Methods: A double blind, randomised placebo controlled study comparing cyclic etidronate and placebo during two years in 37 postmenopausal women receiving long term corticosteroid treatment, mainly for polymyalgia rheumatica (40% of the patients) and rheumatoid arthritis (30%). Bone density was measured in the lumbar spine, femoral neck, and femoral trochanter.

Results: After two years of treatment there was a significant difference between the groups in mean per cent change from baseline in bone density in the spine in favour of etidronate (p = 0.003). The estimated treatment difference (mean (SD)) was 9.3 (2.1)%. Etidronate increased bone density in the spine (4.9 (2.1)%, p < 0.05) whereas the placebo group lost bone (-2.4 (1.6)%). At the femoral neck there was an estimated difference of 5.3 (2.6)% between the groups (etidronate: 3.6% (1.4)%, p < 0.05, placebo: -2.4 (2.1)%). The estimated difference at the trochanter was 8.2 (3.0) (etidronate: 9.0 (1.5)%, p < 0.0001, placebo: 0.5 (2.3)%). No significant bone loss occurred in the hip in placebo treated patients.

Conclusions: Cyclic etidronate is an effective treatment for postmenopausal women receiving corticosteroid treatment and is well tolerated.

Figure 1

Flow diagram of the trial, with numbers of patients.

Figure 2

Per cent changes (compared with baseline, mean (SEM)) bone density in the lumbar spine, femoral neck, and femoral trochanter in the etidronate (closed circles) and placebo (open circles) treated groups. * p<0.05, ** p<0.01, *** p<0.001, **** p<0.0001 compared with baseline.