The role of vitamin D in corticosteroid-induced osteoporosis

A meta- analytic approach

Shreyasee Amin, Michael P. LaValley, Robert W. Simms, David T. Felson

Research output: Contribution to journalArticle

120 Citations (Scopus)

Abstract

Objective. To determine if vitamin D is more effective than no therapy or calcium alone in the management of corticosteroid-induced osteoporosis, and to determine how vitamin D compares with other osteoporosis therapies, e.g., bisphosphonates, calcitonin, or fluoride, for this condition. Methods. We evaluated all formulations of vitamin D, including its active metabolites and analogs. A systematic search for published and unpublished studies was conducted using MEDLINE (1966-December 1997), bibliographic references, abstracts from proceedings of recent national meetings, and contact with pharmaceutical companies and content experts. We included all randomized controlled trials lasting at least 6 months (and reporting extractable results), of patients receiving oral corticosteroids, that compared vitamin D with either 1) no therapy or calcium alone, or 2) bisphosphonates, calcitonin, or fluoride. The primary outcome measure of interest was change in lumbar spine bone mineral density. Results. We found a moderate beneficial effect of vitamin D plus calcium versus no therapy or calcium alone (9 trials) (effect size 0.60; 95% confidence interval [95% CI] 0.34, 0.85; P < 0.0001). In comparisons of vitamin D with other osteoporosis therapies, bisphosphonates were more effective than vitamin D (6 trials) (effect size 0.57; 95% CI 0.09, 1.05). Calcitonin was similar in efficacy to vitamin D (4 trials) (effect size 0.03; 95% CI -0.39, 0.45). Fluoride was more effective than vitamin D, but there were only 2 trials. Conclusion. Vitamin D plus calcium is superior to no therapy or calcium alone in the management of corticosteroid-induced osteoporosis. Vitamin D is less effective than some osteoporosis therapies. Therefore, treatment with vitamin D plus calcium, as a minimum, should be recommended to patients receiving long-term corticosteroids.

Original languageEnglish (US)
Pages (from-to)1740-1751
Number of pages12
JournalArthritis and Rheumatism
Volume42
Issue number8
DOIs
StatePublished - Aug 1999
Externally publishedYes

Fingerprint

Vitamin D
Osteoporosis
Adrenal Cortex Hormones
Calcium
Diphosphonates
Calcitonin
Fluorides
Confidence Intervals
Therapeutics
MEDLINE
Bone Density
Spine
Randomized Controlled Trials
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Immunology
  • Rheumatology

Cite this

The role of vitamin D in corticosteroid-induced osteoporosis : A meta- analytic approach. / Amin, Shreyasee; LaValley, Michael P.; Simms, Robert W.; Felson, David T.

In: Arthritis and Rheumatism, Vol. 42, No. 8, 08.1999, p. 1740-1751.

Research output: Contribution to journalArticle

Amin, Shreyasee ; LaValley, Michael P. ; Simms, Robert W. ; Felson, David T. / The role of vitamin D in corticosteroid-induced osteoporosis : A meta- analytic approach. In: Arthritis and Rheumatism. 1999 ; Vol. 42, No. 8. pp. 1740-1751.
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