[article] Alendronate or alfacalcidol in glucocorticoid-induced osteoporosis [printed text] / R.N. de Nijs, Author ; J.W. Jacobs, Author ; W.F. Lems, Author ; R.F. Laan, Author ; A. Algra, Author ; A.M. Huisman, Author ; E. Buskens, Author ; Chris De Laet  , Author . - 2006 . - 675-84. Languages : English ( eng) in The New England journal of medicine > 355(2006)7 [08/17/2006] . - 675-84
| Descriptors: |
Classification
W 1 Serials. Periodicals
Indexation
Aged ; Bone Density ; Bone Diseases, Metabolic ; Double-Blind Method ; drug therapy ; Female ; Humans ; Journal Article ; Male ; Middle Aged ; Osteoporosis ; Peer Review ; Spine ; United States
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| Abstract: |
BACKGROUND: Treatment with glucocorticoids is associated with bone loss starting soon after therapy is initiated and an increased risk of fracture.
METHODS: We performed a randomized, double-placebo, double-blind clinical trial of 18 months' duration among patients with a rheumatic disease who were starting glucocorticoids at a daily dose that was equivalent to at least 7.5 mg of prednisone. A total of 201 patients were assigned to receive either alendronate (10 mg) and a placebo capsule of alfacalcidol daily or alfacalcidol (1 microg) and a placebo tablet of alendronate daily. The primary outcome was the change in bone mineral density of the lumbar spine in 18 months; the secondary outcome was the incidence of morphometric vertebral deformities.
RESULTS: A total of 100 patients received alendronate, and 101 received alfacalcidol; 163 patients completed the study. The bone mineral density of the lumbar spine increased by 2.1 percent in the alendronate group (95 percent confidence interval, 1.1 to 3.1 percent) and decreased by 1.9 percent in the alfacalcidol group (95 percent confidence interval, -3.1 to -0.7 percent). At 18 months, the mean difference of change in bone mineral density between the two groups was 4.0 percent (95 percent confidence interval, 2.4 to 5.5 percent). Three patients in the alendronate group had a new vertebral deformity, as compared with eight patients in the alfacalcidol group (of whom three had symptomatic vertebral fractures) (hazard ratio, 0.4; 95 percent confidence interval, 0.1 to 1.4).
CONCLUSIONS: During this 18-month trial in patients with rheumatic diseases, alendronate was more effective in the prevention of glucocorticoid-induced bone loss than was alfacalcidol. (ClinicalTrials.gov number, NCT00138983 [ClinicalTrials.gov].). |
| Link for e-copy: |
http://www.nejm.org/doi/pdf/10.1056/NEJMoa053569 |
| Format of e-copy: |
PDF [Open Access] (230 Kb) |
| Record link: |
https://kce.docressources.info/index.php?lvl=notice_display&id=2159 |
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Algemeen kader voor een multidisciplinair kwaliteitshandboek voor cardiale netwerken / Brussels [Belgium] : KCE = Federaal Kenniscentrum voor de Gezondheidszorg = Centre Fédéral d'Expertise des Soins de Santé = Belgian Health Care Knowledge Centre (2013)
