THE EFFECT OF RECTALLY ADMINISTERED STEROIDS ON BONE TURNOVER - A COMPARATIVE-STUDY

Background: Oral glucocorticoids contribute significantly to the risk: of osteoporosis in patients with inflammatory bowel disease. Less wel l established are the effects of rectally administered steroids on bon e metabolism, Aim: To investigate the effects of two widely used recta l foam preparations (prednisolone metasulphobenzoate and hydrocortison e acetate) on biochemical markers of bone turnover, Methods: Twenty-fo ur patients with active inflammatory bowel disease randomly received a standard course of either prednisolone metasulphobenzoate or hydrocor tisone acetate for 2 weeks, Biochemical markers of bone turnover were measured before, during and after treatment, Bone formation markers me asured were serum osteocalcin (BGP) and bone-specific alkaline phospha tase (BALP), Urinary deoxypyridinoline (DPD) was measured to assess bo ne resorption. Results: Disease activity scores improved during treatm ent (difference in mean Powell-Tuck score = 3.4, 95% CI: 2.0-4.8, P < 0.0001) and were similar in both hydrocortisone and prednisolone-treat ed groups. There was no significant reduction in BALP or BGP during tr eatment with either steroid preparation, and urinary DPD did not chang e significantly during treatment. Conclusions: During a 2-week course of rectal hydrocortisone acetate or prednisolone metasulphobenzoate, t here was no significant change in biochemical markers of bone formatio n or resorption, These results suggest that pharmacological doses of r ectal steroid foam preparations do not significantly impair bone turno ver in patients with inflammatory bowel disease.