Vertebral osteoporosis due to high doses of corticoids and cyclosporine ina patient with Still disease.

We report on a 29-year-old patient who received high doses of prednisone an d cyclosporine for the treatment of Still disease. She consulted about dors olumbar pain leading to physical disability. She presented multiple vertebr al fractures, decreased lumbar bone mineral density in the rank of osteopor osis, high bone turnover, and associated hypercalciuria. Cyclosporine and c orticoids induced severe changes in bone and mineral metabolism. All patien ts in treatment with these drugs should undergo radiology, bone densitometr y and biochemical determinations of mineral metabolism at the beginning of therapy. Treatment with high doses of intravenous pamidronate (225 mg in 3 months), calcitonin (200/400 IU daily), tiazide (25 mg/daily), and kinesiot herapy mitigated the pain quickly and she recovered motility. We discuss th is approach of treating osteoporosis with corticoids and immunosuppressors according to the present knowledge of bone biology.