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. 2000;1998(2):CD000952.
doi: 10.1002/14651858.CD000952.

Calcium and vitamin D for corticosteroid-induced osteoporosis

J Homik  1 , M E Suarez-Almazor, B Shea, A Cranney, G Wells, P Tugwell
Affiliations

Calcium and vitamin D for corticosteroid-induced osteoporosis

J Homik et al. Cochrane Database Syst Rev. 2000.

Abstract

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.

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Conflict of interest statement

None known

Figures

1.1
1.1. Analysis
Comparison 1 Calcium and Vitamin D vs Calcium or Placebo, Outcome 1 Bone mineral density, lumbar spine at one year.
1.2
1.2. Analysis
Comparison 1 Calcium and Vitamin D vs Calcium or Placebo, Outcome 2 Bone mineral density, distal radius at one year.
1.3
1.3. Analysis
Comparison 1 Calcium and Vitamin D vs Calcium or Placebo, Outcome 3 Bone mineral density, femoral neck at one year.
1.4
1.4. Analysis
Comparison 1 Calcium and Vitamin D vs Calcium or Placebo, Outcome 4 Drop outs due to adverse effects.
1.5
1.5. Analysis
Comparison 1 Calcium and Vitamin D vs Calcium or Placebo, Outcome 5 Urinary hydroxyyproline to creatinine ratio.
1.6
1.6. Analysis
Comparison 1 Calcium and Vitamin D vs Calcium or Placebo, Outcome 6 Risk of new non‐tramatic fracture.
See this image and copyright information in PMC

References

References to studies included in this review

Adachi 1996 {published data only}
    1. Adachi JD, Bensen WB, Bianchi F, Cividino A, Pillersdorf S, Sebaldt RJ, Tugwell P, Gordon M, Steele M, et al. Vitamin D and calcium in the prevention of corticosteroid induced osteoporosis: A 3 year followup. J Rheumatol 1996;23(6):(pp99 5‐1000). - PubMed
Buckley 1996 {published data only}
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Di Munno 1989 {published data only}
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References to studies excluded from this review

Braun 1983 {published data only}
    1. Braun JJ, Birkenhager‐Frenkel DH, Rietveld AH, Juttmann JR, Visser TJ, Birkenhager JC. Influence of 1 alph‐(OH)D3 administration on bone and bone mineral metabolism in patients on chronic glucocorticoid treatment; a double blind controlled study. Clin En docrinol 1983;19(2):265‐73. - PubMed
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    1. Vogelsang H, Ferenci P, Resch H, Kiss A, Gangl A. Prevention of bone mineral loss in patients with Crohn's disease by long‐term oral vitamin D supplementation. European Journal of Gastroenterology & Hepatology 1995;7:609‐14. - PubMed

Additional references

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