Treatment of Glucocorticoid-Induced Osteoporosis with Bisphosphonates Alone, Vitamin D Alone or a Combination Treatment in Eastern Asians: A Meta-Analysis

Author(s): Junjie Wang, Hongzhuo Li*.

Journal Name: Current Pharmaceutical Design

Volume 25 , Issue 14 , 2019

Abstract:

Background: Glucocorticoid (GC)-induced osteoporosis and fractures have become a serious problem for Eastern Asians. Bisphosphonates (BPs), vitamin D and a combination treatment are effective methods to prevent and treat GC-induced osteoporosis.

Objective: The study aimed to compare the efficacy of BPs, vitamin D and a combination treatment for preventing and managing GC-induced osteoporosis in Eastern Asians.

Methods: A comprehensive search in the PubMed, EMBASE, Web of Science and Cochrane CENTRAL databases was undertaken for randomized controlled trials (RCTs) on the effect of BPs, vitamin D and the combination treatment on GCs-induced osteoporosis in Eastern Asian populations. Primary outcome measures were the change in bone mineral density (BMD) and bone turnover markers. The final search was performed in March 2019.

Results: Nine RCTs were included. A total of 545 patients met the inclusion criteria. Compared with vitamin D, BPs and the combination treatment significantly alleviated osteoporosis of the spine and femoral neck in Eastern Asians with GC-induced osteoporosis. At the same time, the change in serum bone-specific alkaline phosphatase (BAP) and serum C-telopeptide of type I collagen (CTX) levels was observed to be significantly less with BPs and the combination treatment with vitamin D alone. No significant difference was found between BPs and the combination treatment in the markers mentioned above.

Conclusion: Compared with vitamin D alone, BPs alone and the combination treatment were significantly effective on Eastern Asians with GC-induced osteoporosis. Compared with the combination treatment, BPs alone were observed to be effective enough to increase the BMDs of the spine and femoral neck on both sides and thus prevent GC-induced osteoporosis in Eastern Asians.

Keywords: Glucocorticoids, Vitamin D, osteoporosis, Eastern Asians, meta-analysis, randomized controlled trials

[1]
Cohen D, Adachi JD. The treatment of glucocorticoid-induced osteoporosis. J Steroid Biochem Mol Biol 2004; 88(4-5): 337-49. [http://dx.doi.org/10.1016/j.jsbmb.2004.01.003]. [PMID: 15145443].
[2]
Kipen Y, Buchbinder R, Forbes A, Strauss B, Littlejohn G, Morand E. Prevalence of reduced bone mineral density in systemic lupus erythematosus and the role of steroids. J Rheumatol 1997; 24(10): 1922-9. [PMID: 9330933].
[3]
van Staa TP, Leufkens HG, Cooper C. The epidemiology of corticosteroid-induced osteoporosis: A meta-analysis. Osteoporos Int 2002; 13(10): 777-87. [http://dx.doi.org/10.1007/s001980200108]. [PMID: 12378366].
[4]
Oleksik A, Lips P, Dawson A, et al. Health-related quality of life in postmenopausal women with low BMD with or without prevalent vertebral fractures. J Bone Miner Res 2000; 15(7): 1384-92. [http://dx.doi.org/10.1359/jbmr.2000.15.7.1384]. [PMID: 10893688].
[5]
Johnson JM, Franchini G. Retroviral proteins that target the major histocompatibility complex class I. Virus Res 2002; 88(1-2): 119-27. [http://dx.doi.org/10.1016/S0168-1702(02)00124-7]. [PMID: 12297331].
[6]
De Nijs RN. Glucocorticoid-induced osteoporosis: A review on pathophysiology and treatment options. Minerva Med 2008; 99(1): 23-43. [PMID: 18299694].
[7]
Feng Z, Zeng S, Wang Y, Zheng Z, Chen Z. Bisphosphonates for the prevention and treatment of osteoporosis in patients with rheumatic diseases: a systematic review and meta-analysis. PLoS One 2013; 8(12)e80890 [http://dx.doi.org/10.1371/journal.pone.0080890]. [PMID: 24324644].
[8]
Allen CS, Yeung JH, Vandermeer B, Homik J. Bisphosphonates for steroid-induced osteoporosis. Cochrane Database Syst Rev 2016; 10CD001347 [PMID: 27706804].
[9]
Hannan MT, Litman HJ, Araujo AB, et al. Serum 25-hydroxyvitamin D and bone mineral density in a racially and ethnically diverse group of men. J Clin Endocrinol Metab 2008; 93(1): 40-6. [http://dx.doi.org/10.1210/jc.2007-1217]. [PMID: 17986641].
[10]
Wang Y, Jia G, Song J, Kong X, Zhang W, Meng C. Comparative efficacy of alendronate upon vertebral bone mineral density and fracture rates in east asians versus non-east asians with postmenopausal osteoporosis: A systematic review and meta-analysis. Horm Metab Res 2018; 50(10): 738-46. [http://dx.doi.org/10.1055/a-0741-8300]. [PMID: 30312984].
[11]
Kitazaki S, Mitsuyama K, Masuda J, et al. Clinical trial: Comparison of alendronate and alfacalcidol in glucocorticoid-associated osteoporosis in patients with ulcerative colitis. Aliment Pharmacol Ther 2009; 29(4): 424-30. [http://dx.doi.org/10.1111/j.1365-2036.2008.03899.x]. [PMID: 19035979].
[12]
Yamada S, Takagi H, Tsuchiya H, et al. Comparative studies on effect of risedronate and alfacalcidol against glucocorticoid-induced osteoporosis in rheumatoid arthritic patients. Yakugaku Zasshi 2007; 127(9): 1491-6. [http://dx.doi.org/10.1248/yakushi.127.1491]. [PMID: 17827929].
[13]
Fujii N, Hamano T, Mikami S, et al. Risedronate, an effective treatment for glucocorticoid-induced bone loss in CKD patients with or without concomitant active vitamin D (PRIUS-CKD). Nephrol Dial Transplant 2007; 22(6): 1601-7. [http://dx.doi.org/10.1093/ndt/gfl567]. [PMID: 17124283].
[14]
Kikuchi Y, Imakiire T, Yamada M, et al. Effect of risedronate on high-dose corticosteroid-induced bone loss in patients with glomerular disease. Nephrol Dial Transplant 2007; 22(6): 1593-600. [http://dx.doi.org/10.1093/ndt/gfl568]. [PMID: 17041001].
[15]
Okada Y, Nawata M, Nakayamada S, Saito K, Tanaka Y. Alendronate protects premenopausal women from bone loss and fracture associated with high-dose glucocorticoid therapy. J Rheumatol 2008; 35(11): 2249-54. [http://dx.doi.org/10.3899/jrheum.080168]. [PMID: 19031508].
[16]
Takeda S, Kaneoka H, Saito T. Effect of alendronate on glucocorticoid-induced osteoporosis in Japanese women with systemic autoimmune diseases: Versus alfacalcidol. Mod Rheumatol 2008; 18(3): 271-6. [http://dx.doi.org/10.3109/s10165-008-0055-y]. [PMID: 18427724].
[17]
Li EK, Zhu TY, Hung VY, et al. Ibandronate increases cortical bone density in patients with systemic lupus erythematosus on long-term glucocorticoid. Arthritis Res Ther 2010; 12(5): R198. [http://dx.doi.org/10.1186/ar3170]. [PMID: 20964867].
[18]
Tanaka Y, Mori H, Aoki T, et al. Analysis of bone metabolism during early stage and clinical benefits of early intervention with alendronate in patients with systemic rheumatic diseases treated with high-dose glucocorticoid: Early DIagnosis and Treatment of OsteopoRosis in Japan (EDITOR-J) study. J Bone Miner Metab 2016; 34(6): 646-54. [http://dx.doi.org/10.1007/s00774-015-0709-8]. [PMID: 26308708].
[19]
Shin K, Park SH, Park W, et al. Monthly Oral Ibandronate Reduces Bone Loss in Korean Women with Rheumatoid Arthritis and Osteopenia Receiving Long-term Glucocorticoids: A 48-week Double-blinded Randomized Placebo-controlled Investigator-initiated Trial. Clin Ther 2017; 39(2): 268-278.e2. [http://dx.doi.org/10.1016/j.clinthera.2017.01.008]. [PMID: 28161119].
[20]
Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315(7109): 629-34. [http://dx.doi.org/10.1136/bmj.315.7109.629]. [PMID: 9310563].
[21]
Hlaing TT, Compston JE. Biochemical markers of bone turnover - uses and limitations. Ann Clin Biochem 2014; 51(Pt 2): 189-202. [http://dx.doi.org/10.1177/0004563213515190]. [PMID: 24399365].
[22]
Tadrous M, Mamdani MM, Juurlink DN, et al. Comparative gastrointestinal safety of bisphosphonates in primary osteoporosis: A network meta-analysis-reply to pazianas and abrahamsen. Osteoporos Int 2014; 25(11): 2671-2. [http://dx.doi.org/10.1007/s00198-014-2789-z].
[23]
Kan SL, Yuan ZF, Li Y, et al. Alendronate prevents glucocorticoid-induced osteoporosis in patients with rheumatic diseases: A meta-analysis. Medicine 2016; 95(25)e3990 [http://dx.doi.org/10.1097/MD.0000000000003990]. [PMID: 27336902].
[24]
Adachi JD, Roux C, Pitt PI, et al. A pooled data analysis on the use of intermittent cyclical etidronate therapy for the prevention and treatment of corticosteroid induced bone loss. J Rheumatol 2000; 27(10): 2424-31. [PMID: 11036840].
[25]
Orimo H, Nakamura T, Fukunaga M, et al. Effects of alendronate plus alfacalcidol in osteoporosis patients with a high risk of fracture: The Japanese Osteoporosis Intervention Trial (JOINT) - 02. Curr Med Res Opin 2011; 27(6): 1273-84. [http://dx.doi.org/10.1185/03007995.2011.580341]. [PMID: 21554143].
[26]
Park SY, Gong HS, Kim KM, et al. Korean Guideline for the Prevention and Treatment of Glucocorticoid-induced Osteoporosis. J Bone Metab 2018; 25(4): 195-211. [http://dx.doi.org/10.11005/jbm.2018.25.4.195]. [PMID: 30574464].
[27]
Buckley L, Guyatt G, Fink HA, et al. 2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis. Arthritis Care Res (Hoboken) 2017; 69(8): 1095-110. [http://dx.doi.org/10.1002/acr.23279]. [PMID: 28585410].


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Article Details

VOLUME: 25
ISSUE: 14
Year: 2019
Page: [1653 - 1662]
Pages: 10
DOI: 10.2174/1381612825666190619125426

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