Calcium and Vitamin D for Corticosteroid-Induced Osteoporosis

A Cochrane review [Abstract] 1 included 5 studies with a total of 274 subjects taking systemic corticosteroids for various underlying conditions. Calcium plus vitamin D was associated with increase in lumbar spine bone mineral density at 1 year (WMD 2.63, 95% CI 0.74 to 4.53; 3 studies, n=152) and distal radius bone mineral density at 1 year (WMD 2.49, 95% CI 0.62 to 4.36; 3 studies, n=110) The other outcome measures (femoral neck bone mass, fracture incidence, biochemical markers of bone resorption) were not significantly different.

Another systematic review 2 including 21 RCTs with a total of 1 260 subjects was abstracted in DARE. The meta-analysis included 9 comparisons of vitamin D plus calcium versus no therapy or placebo. The effect size for bone mineral density (BMD) was 0.60 (95% CI 0.34 to 0.85). The pooled effect size for Vitamin D plus calcium versus calcium alone was 0.43 (95% CI 0.04 to 0.82). The pooled effect size for incidence of fractures was -0.89, 95% CI -1.90 to 0.12). The effect size of bisphosphonates versus vitamin D plus calcium was 0.57 (95% CI 0.09 to 1.05) in favour of bisphosphonates. The effect size for calcium versus vitamin D was 0.03 (95% CI -0.39 - 0.45).

Comment: The quality of evidence is downgraded by sparse data. Direct evidence of fracture prevention is very limited.

The following decision support rules contain links to this evidence summary:

• Prevention of osteoporosis in long-term use of peroral glucocorticoidshttp://www.ebmeds.org/ebmeds/ebmeds_home.asp?mode=scripts&submode=view&id=scr00012&country=UK

References

• Homik J, Suarez-Almazor ME, Shea B et al. Calcium and vitamin D for corticosteroid-induced osteoporosis. Cochrane Database Syst Rev 2000;(2):CD000952. [PubMed]
• Amin S, LaValley MP, Simms RW, Felson DT. The role of vitamin D in corticosteroid-induced osteoporosis: a meta-analytic approach. Arthritis Rheum 1999 Aug;42(8):1740-51. [PubMed] [DARE]