Background/Purpose: Glucocorticoids (GCs) treatment induces secondary osteoporosis characterized by rapid bone loss and an increase in fracture risk, although GCs are used to treat a wide variety of rheumatic and autoimmune diseases. We have ever investigated the effects of GC therapy on bone metabolic indices and bone mineral density (BMD) in a prospective study. Our previous study indicated that the biochemical markers of bone metabolisim are affected from the early term of GC therapy (day3), and that the simultaneous treatment of alendronate (ALN) with GC therapy (co-dosage group) suppresses the changes of bone turnover markers at the early stage of GC therapy. Moreover, ALN was effective to suppress a reduction in BMD induced by GC. However, the simultaneous treatment of ALN was not effective to suppress an increase in bone resorption markers on day 7 of GC therapy and a reduction in BMD on 1 month. In the present study, we investigated the effects of pre-dosage ALN treatment before GC therapy on rapid bone loss in GC-treated patients prospectively.  

Methods: Twenty-one patients (62.0±9.9 y.o.) treated with prednisolone (PSL) at the dose of over 20 mg received weekly 35mg ALN one day or several days before the initiation of GC therapy (pre-dosage group), and serum Ca, intact parathyroid hormone (PTH), osteocalcin (OC), bone-type alkaline phosphatase (BAP) and urinary levels of type I collagen cross-linked N-telopeptide (NTx) were measured on 7 days, 1, 3 and 6 months after the initiation of GC therapy. BMD values were measured by dual-energy X-ray absorptiometory at the lumbar spine (L2-4) and femoral neck on 1,3,6 and12 months. The subjects were divided into the following two groups; 10 patients receiving PSL at doses³a40mg/day (H) and 11 patients receiving PSL at doses ³a20mg/day (M). 

Results: The pre-dosage ALN treatment caused decreases in serum Ca levels and urinary Ca excretion as well as a significant increase in serum PTH levels (p<0.05) on day 7 of GC treatment, which were not observed in the co-dosage group of our previous study. As for bone-formation indices, serum BAP levels were significantly decreased after 1 month only in the pre-dosage group, although serum OC levels were decreased on day 7 of GC administration in both co-dosage and pre-dosage groups. Although ALN was not effective to suppress an increase in bone resorption markers on day 7 of GC therapy in the co-dosage group, ALN decreased urinary NTx levels in the pre-dosage group. Moreover, BMD at lumbar spine were not decreased at 1 month and significantly increased 6 months after the initiation of GC therapy in the pre-dosage group, although ALN was not effective to suppress a reduction in BMD at 1 month in the co-dosage group. No significant reduction of BMD at femoral neck was observed in the pre-dose group. These results were similar in the subgroup analysis dividing into H and M groups.

Conclusion: The present study suggests that pre-dosage ALN treatment before GC therapy is more effective for the preservation of GC-induced osteoporosis, which might be attributed by early suppression of GC-stimulated bone resorption.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effects-of-pre-dosage-alendronate-treatment-on-bone-metabolic-indices-and-bone-mineral-density-in-patients-treated-with-glucocorticoids-a-prospective-study/