rss
Ann Rheum Dis 1997;56:357-363 doi:10.1136/ard.56.6.357
  • Extended reports

Is addition of sodium fluoride to cyclical etidronate beneficial in the treatment of corticosteroid induced osteoporosis?

  1. Willem F Lemsa,
  2. Johannes W G Jacobsa,
  3. Johannes W J Bijlsmaa,
  4. Gerard J M van Veenb,
  5. Harry H M L Houbenb,
  6. Huub C M Haanenc,
  7. Margot I Gerritsd,
  8. Herman J M van Rijnd
  1. aDepartment of Rheumatology and Clinical Immunology, University Hospital Utrecht, the Netherlands , bDepartment of Rheumatology, de Wever Hospital, Heerlen, the Netherlands , cDepartment of Rheumatology, St Antonius Hospital, Nieuwegein, the Netherlands , dDepartment of Clinical Chemistry, University Hospital Utrecht, the Netherlands
  1. Dr W F Lems, Department of Rheumatology and Clinical Immunology, University Hospital Utrecht, P O Box 85500, 3508 CA Utrecht, the Netherlands.
  • Accepted 3 March 1997

Abstract

OBJECTIVE To investigate whether administration of sodium fluoride (NaF) in addition to cyclical etidronate has a positive effect on bone mineral density (BMD) in patients with established osteoporosis during continued treatment with corticosteroids.

PATIENTS AND METHODS 47 patients who were receiving treatment with corticosteroids were included in a two year randomised, double blind, placebo controlled trial. Established osteoporosis was defined as a history of a peripheral fracture or a vertebral deformity, or both, on a radiograph. All patients were treated with cyclical etidronate, calcium, and either NaF (25 twice daily) or placebo. Vitamin D was supplemented in the case of a low serum 25 (OH) vitamin D concentration. BMD of the lumbar spine and hips was measured at baseline and at 6, 12, 18, and 24 months.

RESULTS After two years of treatment, the BMD of the lumbar spine in the etidronate/NaF group had increased by +9.3% (95% confidence intervals (CI): +2.3% to +16.2%, p<0.01), while the BMD in the etidronate/placebo group was unchanged: +0.3% (95% CI: −2.2% to +2.8%). The difference in the change in BMD between groups was +8.9% (95% CI: +1.9% to +16.0%, p<0.01). For the hips, no significant changes in BMD were observed in the etidronate/NaF group after two years: −2.5% (95% CI: −6.8% to +1.8%); in the etidronate/placebo group BMD had significantly decreased: −4.0% (95% CI: −6.6% to −1.4%; p<0.01). The difference between the groups was not significant: +1.5% (95% CI: −3.4% to +6.4%). No significant differences in number of vertebral deformities and peripheral fractures were observed between the two groups.

CONCLUSION The effect of combination treatment with NaF and etidronate on the BMD of the lumbar spine in corticosteroid treated patients with established osteoporosis is superior to that of etidronate alone.

Footnotes

    This Article

    1. Abstract
    2. Full text
    3. PDF

    Responses

    1. Submit a response
    2. No responses published

    Register for free content

    The full back archive is now available for all BMJ Journals. Institutional subscribers may access the entire archive as part of their subscription. Personal subscribers will also have access to all content when logged in. Non-subscribers who register have free access to all articles published before 2006 right back to volume 1 issue 1. Register here to access the free archive of all BMJ Journals.

    Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.