The role of vitamin D in corticosteroid-induced osteoporosis - A meta-analytic approach

Objective. To determine if vitamin D is more effective than no therapy or c alcium alone in the management of corticosteroid-induced osteoporosis, and to determine how vitamin D compares with other osteoporosis therapies, e.g. , bisphosphonates, calcitonin, or fluoride, for this condition. Methods. We evaluated all formulations of vitamin D, including its active m etabolites and analogs. A systematic search for published and unpublished s tudies was conducted using MEDLINE (1966-December 1997), bibliographic refe rences, abstracts from proceedings of recent national meetings, and contact with pharmaceutical companies and content experts. We included all randomi zed controlled trials lasting at least 6 months land reporting extractable results), of patients receiving oral corticosteroids, that compared vitamin D with either 1) no therapy or calcium alone, or 2) bisphosphonates, calci tonin, or fluoride. The primary outcome measure of interest was change in l umbar spine bone mineral density. Results, We found a moderate beneficial effect of vitamin D plus calcium ve rsus no therapy or calcium alone (9 trials) (effect size 0.60; 95% confiden ce interval [95% CI] 0.34, 0.85; P < 0.0001). In comparisons of vitamin D w ith other osteoporosis therapies, bisphosphonates were more effective than vitamin D (6 trials) (effect size 0.57; 95% CI 0.09, 1.05). Calcitonin was similar in efficacy to vitamin D (9 trials) (effect size 0.03; 95% CI -0.39 , 0.45). Fluoride was more effective than vitamin D, but there were only 2 trials. Conclusion. Vitamin D plus calcium is superior to no therapy or calcium alo ne in the management of corticosteroid-induced osteoporosis. Vitamin D is l ess effective than some osteoporosis therapies, Therefore, treatment with v itamin D plus calcium, as a minimum, should be recommended to patients rece iving long-term corticosteroids.