Decreased bone mineral density during low dose glucocorticoid administration in a randomized, placebo controlled trial

Objective. While osteoporosis and bone fractures are clearly recognized sid e effects of high dose glucocorticoids, the effect of low dose glucocortico ids remains controversial. We investigated the effect of 3 months of low do se hydrocortisone on bone mineral density (BMD). Methods. Subjects, 18 to 55 years old with chronic fatigue syndrome and no medical or psychiatric illness requiring medication, were randomized in a d ouble blind, placebo controlled trial to receive oral hydrocortisone, 13 mg /m(2) body surface area every morning and 3 mg/m(2) every afternoon (25 to 35 mg/day, equivalent to about 7.5 mg prednisone/day) or placebo for 12 wee ks. Before and after treatment BMD of the lumbar spine was measured by dual energy x-ray absorptiometry. Results. We studied 23 subjects (19 women, 4 men). For the 11 hydrocortison e recipients there was a mean decrease in BMD: mean change from baseline of the lateral spine was -2.0% (95% CI -3.5 to -0.6, p = 0.03) and mean chang e of the anteroposterior spine was -0.8% (95% CI -1.5 to -0.1, p = 0.06). C orresponding changes for the 12 placebo recipients were +1.0% (95% CI -1.0 to 3.0, p = 0.34) and +0.2% (95% CI -1.4 to 1.5, p = 0.76). Conclusion. A 12 week course of low dose glucocorticoids given to ambulator y subjects with chronic fatigue syndrome was associated with a decrease in BMD of the lumbar spine. This decrease was statistically significant in lat eral spine measurements and nearly so in anteroposterior spine measurements .