Effect of Weight Reduction and Calcitriol Treatment for the Obese Patients with Glucocorticoid Induced Osteoporosis

Lee, Chang Beom

Abstract

BACKGROUND: To evaluate effect of calcitrtiol on the bone mineral density changes after weight reduction of obese patients with glucocorticoid induced osteoporosis.
METHODS
The study sample consisted of the glucocorticoid group, which included 53 females (age: 60.3 +/- 5.9 yr) who were taking glucocorticoid and were being followed up at our hospital for rheumatoid arthritis and osteoarthritis, and the control group, which included 50 females (age: 59.3 +/- 3.0 yr) who had the same diseases but were not on glucocorticoid. All of the patients from the glucocorticoid group were taking triamcinolone in dose greater than 2 mg/day for more than 6 months for rheumatoid arthritis. Patients from both groups received obesity treatment for knee joint pain, and also calcitriol 0.25 microgram and calcium 1,000 mg. The effects of those drugs were evaluated by annual QCT (Quantitative Computed Tomography) measurement of BMD (Bone mineral density).
RESULTS
There was no significant difference in the initial BMD between the control and the glucocorticoid group (75.9 vs 70.1 mg/cm2, P > 0.05). No significant improvement in BMD was noted in either group since the initial treatment until after a year, even when analyzed in terms of different age groups. After one year of treatment, the percentages of patients with a decrease in BMD of over 3% in the age groups of less than 60 years for control group and glucocorticoid group were 30% and 38%, respectively (P > 0.05). However, among the age groups of 60 and above, 44% of the glucocorticoid group showed a decrease in BMD of greater than 3% compared to 33% of the control group. Therefore, a significantly higher ratio of patients from the glucocorticoid group showed a decrease in BMD compared to the control group after the age of 59 (P < 0.05).
CONCLUSION
The patient's age must be taken into consideration when deciding the use of glucocorticoid in rheumatoid arthritis patients, The antiresorptive calcitriol did not protect against the harmful effects of glucocorticoid. Further studies involving larger study population are needed to elucidate whether weight loss has any negative effect on bone metabolism.