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Glucocorticoid-related bone loss prevented with zoledronate

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – A single dose of zoledronate prevents bone loss associated with glucocorticoid therapy given for acute exacerbation of Crohn’s disease, a German team reports in the American Journal of Gastroenterology online March 8.

As the authors point out, osteoporosis is common in patients with Crohn’s disease, and one important factor is the use of glucocorticoids, “a treatment mainstay for chronic inflammatory diseases.”

Dr. Jochen Klaus, with Universitatsklinikum Ulm, and colleagues assessed the effectiveness of intravenous zoledronate added to cholecalciferol and calcium for preventing bone loss in Crohn’s disease patients just starting a course of prednisolone for acute disease flare.

Forty such patients were randomized to receive 4 mg zoledronate intravenously or placebo just before the first dose of prednisolone. All patients received 400 mg b.i.d. calcium citrate and 1,000 IU cholecalciferol daily. The glucocorticoid dose was tapered from 60 mg daily to none in weekly steps over 10 weeks.

Bone mineral density of the lumbar spine was measured by dual X-ray absorptiometry at baseline and at 90 days. The zoledronate group showed a 37.5% increase in BMD while the placebo groups had a 27.5% decrease, the researchers report. The difference between the groups “was highly significant (p=0.006).”

Zoledronate was well tolerated, the team found. Flu-like symptoms were reported by four patients after zoledronate infusion and by two after placebo infusion.

Dr. Klaus and colleagues advise, “To avoid osteoporosis and associated significant disease burden on patient’s life and today’s health care system, zoledronate along with calcium and c(h)olecalciferol should be considered whenever a glucocorticoid therapy is started to treat acute flare in Crohn’s disease patients.”

Am J Gastroenterol 2011.