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

G Haugeberg, B Griffiths, K B Sokoll, P Emery

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

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