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Ann Rheum Dis. 1998 December; 57(12): 724–727.
PMCID: PMC1752511

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


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.

Keywords: etidronate; calcium; bone density; corticosteroid induced osteoporosis

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Selected References

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  • Walsh LJ, Wong CA, Pringle M, Tattersfield AE. Use of oral corticosteroids in the community and the prevention of secondary osteoporosis: a cross sectional study. BMJ. 1996 Aug 10;313(7053):344–346. [PMC free article] [PubMed]
  • Hahn TJ, Hahn BH. Osteopenia in patients with rheumatic diseases: principles of diagnosis and therapy. Semin Arthritis Rheum. 1976 Nov;6(2):165–188. [PubMed]
  • Adinoff AD, Hollister JR. Steroid-induced fractures and bone loss in patients with asthma. N Engl J Med. 1983 Aug 4;309(5):265–268. [PubMed]
  • Hooyman JR, Melton LJ, 3rd, Nelson AM, O'Fallon WM, Riggs BL. Fractures after rheumatoid arthritis. A population-based study. Arthritis Rheum. 1984 Dec;27(12):1353–1361. [PubMed]
  • Butler RC, Davie MW, Worsfold M, Sharp CA. Bone mineral content in patients with rheumatoid arthritis: relationship to low-dose steroid therapy. Br J Rheumatol. 1991 Apr;30(2):86–90. [PubMed]
  • Dykman TR, Gluck OS, Murphy WA, Hahn TJ, Hahn BH. Evaluation of factors associated with glucocorticoid-induced osteopenia in patients with rheumatic diseases. Arthritis Rheum. 1985 Apr;28(4):361–368. [PubMed]
  • Cooper C, Coupland C, Mitchell M. Rheumatoid arthritis, corticosteroid therapy and hip fracture. Ann Rheum Dis. 1995 Jan;54(1):49–52. [PMC free article] [PubMed]
  • Sambrook P, Birmingham J, Kempler S, Kelly P, Eberl S, Pocock N, Yeates M, Eisman J. Corticosteroid effects on proximal femur bone loss. J Bone Miner Res. 1990 Dec;5(12):1211–1216. [PubMed]
  • Sambrook P, Birmingham J, Kelly P, Kempler S, Nguyen T, Pocock N, Eisman J. Prevention of corticosteroid osteoporosis. A comparison of calcium, calcitriol, and calcitonin. N Engl J Med. 1993 Jun 17;328(24):1747–1752. [PubMed]
  • Adachi JD, Bensen WG, Brown J, Hanley D, Hodsman A, Josse R, Kendler DL, Lentle B, Olszynski W, Ste-Marie LG, et al. Intermittent etidronate therapy to prevent corticosteroid-induced osteoporosis. N Engl J Med. 1997 Aug 7;337(6):382–387. [PubMed]
  • Adachi JD, Bensen WG, Bianchi F, Cividino A, Pillersdorf S, Sebaldt RJ, Tugwell P, Gordon M, Steele M, Webber C, et al. Vitamin D and calcium in the prevention of corticosteroid induced osteoporosis: a 3 year followup. J Rheumatol. 1996 Jun;23(6):995–1000. [PubMed]
  • Reid IR, Heap SW, King AR, Ibbertson HK. Two-year follow-up of biphosphonate (APD) treatment in steroid osteoporosis. Lancet. 1988 Nov 12;2(8620):1144–1144. [PubMed]
  • Dykman TR, Haralson KM, Gluck OS, Murphy WA, Teitelbaum SL, Hahn TJ, Hahn BH. Effect of oral 1,25-dihydroxyvitamin D and calcium on glucocorticoid-induced osteopenia in patients with rheumatic diseases. Arthritis Rheum. 1984 Dec;27(12):1336–1343. [PubMed]
  • Buckley LM, Leib ES, Cartularo KS, Vacek PM, Cooper SM. Calcium and vitamin D3 supplementation prevents bone loss in the spine secondary to low-dose corticosteroids in patients with rheumatoid arthritis. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 1996 Dec 15;125(12):961–968. [PubMed]
  • Saag KG, Emkey R, Schnitzer TJ, Brown JP, Hawkins F, Goemaere S, Thamsborg G, Liberman UA, Delmas PD, Malice MP, et al. Alendronate for the prevention and treatment of glucocorticoid-induced osteoporosis. Glucocorticoid-Induced Osteoporosis Intervention Study Group. N Engl J Med. 1998 Jul 30;339(5):292–299. [PubMed]
  • Struys A, Snelder AA, Mulder H. Cyclical etidronate reverses bone loss of the spine and proximal femur in patients with established corticosteroid-induced osteoporosis. Am J Med. 1995 Sep;99(3):235–242. [PubMed]
  • Adachi J, Cranney A, Goldsmith CH, Bensen WG, Bianchi F, Cividino A, Craig GL, Kaminska E, Sebaldt RJ, Papaioannou A, et al. Intermittent cyclic therapy with etidronate in the prevention of corticosteroid induced bone loss. J Rheumatol. 1994 Oct;21(10):1922–1926. [PubMed]
  • Gallacher SJ, Fenner JA, Anderson K, Bryden FM, Banham SW, Logue FC, Cowan RA, Boyle IT. Intravenous pamidronate in the treatment of osteoporosis associated with corticosteroid dependent lung disease: an open pilot study. Thorax. 1992 Nov;47(11):932–936. [PMC free article] [PubMed]
  • Sebaldt RJ, Adachi JD, Bensen WG, Bianchi F, Cividano A, Craig GL, Cranney A, Kaminska E, Gordon M, Steele M, et al. Intermittent cyclic therapy with etidronate prevents corticosteroid-induced bone loss: two years of follow-up. Scand J Rheumatol Suppl. 1996;103:91–93. [PubMed]
  • Boutsen Y, Jamart J, Esselinckx W, Stoffel M, Devogelaer JP. Primary prevention of glucocorticoid-induced osteoporosis with intermittent intravenous pamidronate: a randomized trial. Calcif Tissue Int. 1997 Oct;61(4):266–271. [PubMed]
  • Mulder H, Struys A. Intermittent cyclical etidronate in the prevention of corticosteroid-induced bone loss. Br J Rheumatol. 1994 Apr;33(4):348–350. [PubMed]
  • Diamond T, McGuigan L, Barbagallo S, Bryant C. Cyclical etidronate plus ergocalciferol prevents glucocorticoid-induced bone loss in postmenopausal women. Am J Med. 1995 May;98(5):459–463. [PubMed]
  • Storm T, Thamsborg G, Steiniche T, Genant HK, Sørensen OH. Effect of intermittent cyclical etidronate therapy on bone mass and fracture rate in women with postmenopausal osteoporosis. N Engl J Med. 1990 May 3;322(18):1265–1271. [PubMed]
  • Reid IR, Ibbertson HK. Calcium supplements in the prevention of steroid-induced osteoporosis. Am J Clin Nutr. 1986 Aug;44(2):287–290. [PubMed]
  • Bijlsma JW, Raymakers JA, Mosch C, Hoekstra A, Derksen RH, Baart de la Faille H, Duursma SA. Effect of oral calcium and vitamin D on glucocorticoid-induced osteopenia. Clin Exp Rheumatol. 1988 Apr-Jun;6(2):113–119. [PubMed]
  • Verhoeven AC, Boers M. Limited bone loss due to corticosteroids; a systematic review of prospective studies in rheumatoid arthritis and other diseases. J Rheumatol. 1997 Aug;24(8):1495–1503. [PubMed]

Figures and Tables

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, ...

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