CALCIUM AND VITAMIN-D-3 SUPPLEMENTATION PREVENTS BONE LOSS IN THE SPINE SECONDARY TO LOW-DOSE CORTICOSTEROIDS IN PATIENTS WITH RHEUMATOID-ARTHRITIS - A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL

Background: Therapy with low-dose corticosteroids is commonly used to treat allergic and autoimmune diseases. Long-term use of corticosteroi ds can lead to loss of bone mineral density and higher risk for verteb ral fractures. Calcium and vitamin D-3 supplementation is rational the rapy for minimizing bone loss, but little evidence for its effectivene ss exists. Objective: To assess 1) the effects of supplemental calcium and vitamin D-3 on bone mineral density of patients with rheumatoid a rthritis and 2) the relation between the effects of this supplementati on and corticosteroid use. Design: 2-year randomized, double-blind, pl acebo controlled trial. Setting: University outpatient-care facility. Patients: 96 patients with rheumatoid arthritis, 65 of whom were recei ving treatment with corticosteroids (mean dosage, 5.6 mg/d). Intervent ion: Calcium carbonate (1000 mg/d) and vitamin D-3 (500 IU/d) or place bo. Measurements: Bone mineral densities of the lumbar spine and femur were determined annually. Results: Patients receiving prednisone ther apy who were given placebo lost bone mineral density in the lumbar spi ne and trochanter at a rate of 2.0% and 0.9% per year, respectively. P atients receiving prednisone therapy who were given calcium and vitami n D-3 gained bone mineral density in the lumbar spine and trochanter a t a rate of 0.72% (P = 0.005) and 0.85% (P = 0.024) per year, respecti vely. In patients receiving prednisone therapy, bone mineral densities of the femoral neck and the Ward triangle did not increase significan tly with calcium and vitamin D-3. Calcium and vitamin D-3 did not impr ove bone mineral density at any site in patients who were not receivin g corticosteroids. Conclusion: Calcium and vitamin D-3 prevented loss of bone mineral density in the lumbar spine and trochanter in patients with rheumatoid arthritis who were treated with low-dose corticostero ids.