Alendronate or alfacalcidol with corticosteroids?
N Engl J Med. 2006 Aug 17;355(7)675-84. Alendronate or alfacalcidol in glucocorticoid-induced osteoporosis. de Nijs RN and others. PMID: 16914703. When people need treatment with glucocorticoids (corticosteroids such as cortisone), they often develop osteoporosis or osteopenia as a side effect of the steroid medication with resulting increased risk of fractures. This 18-month study compared the effectiveness at preventing bone mineral density (BMD) decrease when 10 mg alendronate (Fosamax) or 1 microg of alfacalcidol (see here for information on alfacalcidol) was given daily to people receiving at least a 7.5mg prednisone-equivalent dose of glucocorticoids. One hundred people received alendronate and 101 received alfacalcidol, with 163 people completing the study. Results showed a mean lumbar spine bone density increase of 2.1 percent in the alendronate group and a 1.9% decrease in the alfacalcidol group for a total 4% improvement when comparing the two groups. The authors concluded: “During this 18-month trial in patients with rheumatic diseases, alendronate was more effective in the prevention of glucocorticoid-induced bone loss than alfacalcidol. Editor's comments: This study confirms what many others have shown: basically that alendronate is superior to any form of vitamin D at increasing BMD or preventing its loss, as in the case of individuals on some form of steroid therapy. See PMID: 10525709 to see how much more effective alendronate was compared to alfacalcidol in a clinical trial of Japanese patients with osteoporosis. I suspect there is a tendency by practitioners to prescribe a much cheaper medication such as some form of vitamin D when trying to prevent loss of BMD. These studies, however, demonstrate that you get what you pay for, and that alendronate (or most likely some other approved bisphosphonate) is more effective. This can be extremely important since painful fractures are often the end result of inadequate prevention of bone loss.
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