HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS REGISTER		Author Keyword(s) Vol Page [Advanced]

This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this link to a friend Similar articles in this journal Similar articles in PubMed Add article to my folders Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Haugeberg, G Articles by Emery, P Search for Related Content PubMed PubMed Citation Articles by Haugeberg, G Articles by Emery, P

Bone loss in patients treated with pulses of methylprednisolone is not negligible: a short term prospective observational study

Academic Unit of Musculoskeletal Disease, Department of Rheumatology, University of Leeds, UK

Correspondence to:
Correspondence to:
Professor P Emery
Department of Rheumatology, 1st Floor, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK; p.emery{at}leeds.ac.uk

Objective: To examine the influence of intravenous pulsed methylprednisolone (MP) on bone mass.

Methods: 38 patients (30 women) with various rheumatic disorders requiring intravenous MP pulse treatment were examined at baseline and after 6 months with dual energy x ray absorptiometry (DXA), measuring hip and lumbar spine bone mineral density (BMD). Demographic and clinical data were collected.

Results: Demographics showed: mean (SD) age 48.4 (16.3) years, body mass index 24.9 (5.1) kg/m², and median (range) disease duration 3.2 (0.1–40.0) years. During follow up patients received a mean cumulative MP dose of 3.0 (1.6) g given as 5.7 (2.0) pulses over a median period of 5.7 (2.3–33.7) months. 34/38 (89%) patients were also pulsed with cyclophosphamide, 20 (53%) were taking oral corticosteroids, and 8 (21%) were using either bisphosphonates or oestrogen. At the end of the study mean BMD was reduced by –2.2% at the femoral neck, –1.1% at the total hip, and –1.0% at the spine L2-4. In subgroups BMD increased in patients treated with bisphosphonates or oestrogen (femoral neck +1.6%, total hip +3.2%, spine L2-4 +4.5%), whereas BMD decreased at all sites in patients not treated with antirersorptive treatment, both for users (femoral neck –4.4%, total hip –2.4%, spine L2-4 –2.1%) and non-users of concomitant oral prednisolone (femoral neck –1.7%, total hip –1.9%, spine L2-4 –2.6%).

Conclusion: Treatment with intravenous pulses of MP leads to a high rate of bone loss. Prevention of bone loss in these patients with bisphosphonates and oestrogens should be considered.

Abbreviations: ANOVA, analysis of variance; ART, antiresorptive osteoporosis treatment; BMD, bone mineral density; CS, corticosteroids; DXA, dual energy x; ESR, erythrocyte sedimentation rate; HRT, hormone replacement therapy; MP, methylprednisolone

Keywords: bone mineral density; methylprednisolone; osteoporosis

This article has been cited by other articles:

				E. Wall and K. Walker-Bone Use of bisphosphonates and dual-energy X-ray absorptiometry scans in the prevention and treatment of glucocorticoid-induced osteoporosis in rheumatology QJM, April 1, 2008; 101(4): 317 - 323. [Abstract] [Full Text] [PDF]

				Y. Kikuchi, T. Imakiire, M. Yamada, T. Saigusa, T. Hyodo, T. Kushiyama, K. Higashi, N. Hyodo, K. Yamamoto, S. Suzuki, et al. Effect of risedronate on high-dose corticosteroid-induced bone loss in patients with glomerular disease Nephrol. Dial. Transplant., June 1, 2007; 22(6): 1593 - 1600. [Abstract] [Full Text] [PDF]

				A. Kreuter, T. Gambichler, F. Breuckmann, S. Rotterdam, M. Freitag, M. Stuecker, K. Hoffmann, and P. Altmeyer Pulsed High-Dose Corticosteroids Combined With Low-Dose Methotrexate in Severe Localized Scleroderma Arch Dermatol, July 1, 2005; 141(7): 847 - 852. [Abstract] [Full Text] [PDF]