Extended reports
Effects of cyclical etidronate combined with calcitriol versus
cyclical etidronate alone on spine and femoral neck bone mineral
density in postmenopausal osteoporotic women
a Department of Integrated
Medicine, City Hospital, Nottingham, b Department
of Rheumatology, Whipps Cross Hospital, London, c Department of Rheumatology, St Thomas's Hospital, London
Correspondence to: Dr T Masud, Department of Integrated Medicine, City Hospital NHS Trust, Hucknall Road, Nottingham NG5 1PB.
Accepted for publication 7 May 1998
OBJECTIVES
Few data are available on the effects
of combination therapy for the treatment of osteoporosis. The aim of
this study was to compare the effects of intermittent cyclical
etidronate (E) therapy alone with a combination of cyclical etidronate
and calcitriol (E+C) on spine and femoral neck bone mineral density
(BMD) at one year.
METHODSPostmenopausal women with at least one
non-traumatic vertebral fracture or z score < 
1.5 were randomly
allocated to an E group (each cycle = oral etidronate 400 mg daily for
14 days followed by calcium 500 mg daily for 76 days) or an E+C group
(as for E plus oral calcitriol 0.5 µg daily). Lumbar spine and
femoral neck BMDs were measured by dual energy x ray
absorptiometry at baseline and at one year. The study design did not
contain a placebo group.
RESULTSThe mean % increase in lumbar spine BMD
was 5.2% (95%CI= 3.4 to 7.0) in the E+C group (n=24), which was
significantly greater than the 2.7% (95%CI= 1.3 to 4.1) increase in
the E group (n=23) (p<0.05). The femoral neck BMD in the E+C group
increased by 2.0% (95%CI= 0.8 to 3.2), which was significantly
different from the E group where there was a 0.4% (95%CI=2.4 to
1.6) change (p=0.046).
CONCLUSIONSThese data show that a combination of
cyclical etidronate and calcitriol is better than cyclical etidronate
alone in terms of changes in BMD at both spine and femoral neck sites.
Although further data are needed on fracture efficacy, this study
suggests that combination therapies have additive therapeutic potential that may exceed that expected from their theoretical mode of action.
© 1998 by Annals of the Rheumatic Diseases
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