Steroids: osteoporosis: bisphophonates increase lumbar spine bone mineral density

Clinical bottom line (level 1a)

  1. Patients on steroids who take bisphosphonates compared with placebo have increased lumbar spine bone mineral density.
  2. The effect on fracture rates is unclear.
Blair et al: J Fam Pract 2000; 49 : 839-848
Expires May 2004

The study

Systematic review of all randomised controlled trials of
  • Patients: on steroids
  • Intervention: oral bisphosphonates compared with control
  • Outcome: osteoporosis

Articles found in English using Medline, Current Contents, Healthstar, (search terms: bisphosphonates, diphosphonates, glucocorticoids, steroids and osteoporosis ) and searching blbiographies of selected artlces and recent meeting abstracts

Selection criteria: by 2 independent reviewers
Appraisal criteria: by 2 independent reviewers: using Jadad criteria
Articles excluded if:
  • studied children
  • osteoporosis not assessed using central DEXA
13 RCTs found involving 1711 patients taking risedronate, etidronate, alendronate, and clodronate

The evidence

  • 10 studies showed a significant increase in lumbar spine bone mineral density (BMD) using bisphosphonate compared with placebo. Only 4 showed a significant increase in femoral neck BMD.
  • No formal meta-analysis was performed on the effect on fracture risk or adverse effects.

Citation

  1. Blair MM, Stier Carson D, Barrington R: bisphosphonates in the prevention and treatment of glucocorticoid-induced osteoporosis. J Fam Pract 2000; 49 : 839-848
Search Terms: from ACP Journal Club other articles noted
Contributor: Chris Ball, May 2002
Reviewer:

Clinical Question.
Patient on steroids
Intervention or Exposure bisphosphonates
Comparison placebo
Outcome bone mineral density, fracture rate