High incidence rate of vertebral fractures during chronic prednisone treatment, in spite of bisphosphonate or alfacalcidol use. Extension of the 'Alendronate or alfacalcidol in glucocorticoid-induced osteoporosis'-trial.

Clinical and Experimental Rheumatology

Johannes WJ Bijlsma¹  Ron NJ De Nijs¹  Willem F Lems¹  Harry MJ Hulsmans¹  Johannes WG Jacobs¹  Piet PMM Geusens¹  Jos N Hoes¹  George AW Bruyn¹ 

关键词: Glucocorticoid induced osteoporosis;    bisphosphonate;    vitamin D;    alendronate;    alfacalcidol;    rheumatic disease;    vertebral fracture;    STOP-trial;   

DOI  :  

学科分类：医学（综合）

来源: Pacini Editore SpA

【 摘 要 】

OBJECTIVES: In the 18 month "alendronate or alfacalcidol in glucocorticoid-induced osteoporosis"-trial (STOP-trial) patients with rheumatic diseases who started glucocorticoids were randomised to anti-osteoporosis therapy with either daily alendronate (10 mg) or alfacalcidol (1 μg). In the present observational open follow-up study of the STOP-trial, we report the long-term effects of risk factors on the incidence and pattern of vertebral fractures, assessed using the Genant method. RESULTS: Of the 201 included patients in the STOP-trial, 163 completed the trial and of those 116 underwent a follow-up radiography of the spine. Twenty-eight patients had developed one or more new vertebral fractures since the end of the STOP-trial. The majority of fractures was wedge shaped and the deformities were intermediate to severe in both the former alendronate and alfacalcidol group. Multiple logistic regression analysis showed that STOP-trial medication and presence of pre-existing fractures did not predict development of new fractures, whereas age and cumulative glucocorticoid-dose did. CONCLUSIONS: During the follow-up 2.7 years after the STOP-trial both in the former alendronate and alfacalcidol group 24% of the patients underwent at least one new vertebral fracture. This underlines that prevention of vertebral fractures remains a clinical challenge, even when anti-osteoporosis drugs are prescribed.

【 授权许可】

Unknown