Deflazacort versus prednisone in patients with giant cell arteritis: Effects on bone mass loss

Objective. To compare bone mass loss due to deflazacort versus prednisone i n longterm treatment of patients with giant cell arteritis (GCA) in a rando mized double blind comparative trial. Methods. Seventy-four patients were included in a prospective multicenter s tudy. Half received deflazacort (DFZ) and the other half prednisone (PR) fo r a minimum of 12 months. Calcium and vitamin D supplements were also provi ded to all subjects. Our intent was (1) to evaluate bone mineral density, u sing dual energy x-ray absorptiometry, at baseline and comparatively at 3, 6, and 12 mo; vertebral fractures by Meunier score and size variations afte r 12 mo treatments were also analyzed; (2) to assess calcium/phosphate meta bolism modifications in both groups at baseline and after 12 mo. Results. No significant difference was observed between the 2 groups in ter ms of treatment efficacy. Patients taking PR were slightly older on average versus the DFZ group (74 vs 70 yrs). Bone mass loss between entry and mont h 12 was not statistically different in the PR group (-0.026 +/- 0.007 g/cm (2)) compared to the DFZ group (-0.03 +/- 0.005 g/cm(2)). No significant di fference was found in Meunier score variations (0.77 and 1.18 in the PR and DFZ groups, respectively; p = 0.3), nor in vertebral size variations (-0.4 and -0.2 in the PR and DFZ groups, respectively; p = 0.4). There was no di fference in calcium/phosphate metabolism evaluations at month 12. Conclusion. In older patients taking longterm glucocorticoids who are at ri sk of osteoporosis, deflazacort did not result in less bone loss than predn isone.