ALENDRONATE FOR THE PREVENTION OF GLUCOCORTICOID-INDUCED OSTEOPOROSIS IN POSTMENOPAUSAL WOMEN WITH RHEUMATOID ARTHRITIS

Background: Secondary osteoporosis is a common complication of steroid therapy.The situation became more serious if the steroid treated patients are old postmenopausal women(PMW)suffer from a generalised inflammatory condition such as Rheumatoid arthritis(RA).Studies concern the prevention or treatment of osteopenia in these patients are very rare.It is well known that Alendronate(ALN)is a very potent bisphosphonate that increases the bone mineral density (BMD) of the spine and hip in PMW with Osteoporosis.Objectives: In order to evaluate the potential action of this agent on PMW suffer from RA and treated with steroids we carried out an one year open multicenter trial.Methods: 95 PMW(MA=61,6±6,1 yrs)suffer from RA (Mean duration of the disease 10,09 yrs)and received prednisone (mean dose 7,4±2,8 mg/d)before ALN (Mean time=18,3±28,6 months).At baseline 18 patients were osteopenic,10 normal and the rest 67 osteoporotic according to WHO criteria(measured by Lunar DPL-L and Hologic 1000QDR machines)at Lumbar Spine(LS)and/or Hip(Neck).All patients were treated for 1 year with ALN 10mg/d plus calcium 500mg/d plus Alfacalcidol 0,25ìg EOD and prednisone 5 to 10mg/d(mean dose 7,1±3,2 mg/d)according to the needs of patient.They received also Methotrexate(58),Hydroxychloroquine(9),Cyclosporin(3)and NSAIDs ad hoc.The patients were seen at 6 ms and at the end of the study with a new DEXA using the same DEXA machine.Our primary end point was to evaluate the difference in the mean percent change in LS and Hip BMD from baseline.Results: Our results show that with this treatment schedule the mean BMD increased by 2,8± 2,4 percent at LS and by 2,1± 1,79 percent at Hip(Neck)Conclusion: According to these results it seems that Alendronate at a dose of 10mg/d plus Calcium 500mg/d plus Alfacalcidol 0,25 μg EOD increases the BMD and preserve the bone mass in postmenopausal women suffer from Rheumatoid Arthritis and received prednisone at a mean dose of 7,1 mg/d for 1 year.Citation: , volume , supplement , year 2002, page Session: Osteoporosis – Clinical aspects and treatment