RESEARCH - Effects of low-dose prednisone on bone metabolism

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J Bone Miner Res. 2005 Mar;20(3):464-70. Epub 2004 Nov 29. Related

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Effects of low-dose prednisone on bone metabolism.

Ton FN, Gunawardene SC, Lee H, Neer RM.

Endocrinology Unit, Massachusetts General Hospital, Boston, Massachusetts

02114, USA. fton@...

Prednisone 5 mg/day suppresses multiple indices of bone formation in a

randomized placebo-controlled trial in healthy postmenopausal females. This

suggests that even low doses of prednisone may reduce bone repair or renewal

and may have adverse effects on bone mass and/or bone strength.

INTRODUCTION: High doses of chronic glucocorticoids are known to have

adverse effects on bone, and measures to prevent bone loss are well

established for doses >7.5 mg daily, because these doses can cause premature

or exaggerated osteoporosis. However, it is unclear if chronic prednisone

doses of 5 mg daily have the same effects on bone. There are no established

recommendations for preventing glucocorticoid-induced osteoporosis in people

taking prednisone 5 mg daily, a dose used frequently in medical practice to

treat diseases of the lungs, joints, skin, muscles, eyes, nerves, etc. Our

primary objective was to test whether prednisone 5 mg daily affects serum

and urine indices of bone metabolism in healthy postmenopausal women. Our

secondary objectives were to determine if prednisone 5 mg affected systolic

or diastolic blood pressure or causes side effects.

MATERIALS AND METHODS: A double-blinded randomized placebo-controlled 8-week

trial in 50 healthy postmenopausal women was conducted at the Massachusetts

General Hospital Outpatient General Clinical Research Center. Patients were

randomly assigned to prednisone 5 mg daily or matching placebo for 6 weeks,

followed by a 2-week recovery phase. Markers of bone formation and

resorption were determined at weeks 0, 2, 4, 6, and 8. Indices of osteoblast

activity included serum propeptide of type I N-terminal procollagen (PINP),

propeptide of type I C-terminal procollagen (PICP), osteocalcin, and

bone-specific alkaline phosphatase (BSALP). Indices of osteoclast activity

included urine and serum type I collagen N- elopeptide (NTX) and free

urinary deoxypyridinoline (DPD).

RESULTS AND CONCLUSIONS: Prednisone rapidly and significantly decreased

serum PINP (p < 0.01), PICP (p < 0.01), and osteocalcin (p < 0.01) and free

urinary deoxypyridinoline (p = 0.017). These changes were largely reversed

during the recovery period. Side effects were indistinguishable in the two

groups. Neither systolic nor diastolic blood pressure changed significantly

throughout the study between the two groups. In conclusion, low-dose

prednisone significantly decreases indices of bone formation and may

decrease indices of bone resorption in postmenopausal women. Further studies

are needed to assess the effects of low-dose prednisone on BMD and fracture

risk.

PMID: 15746991

FULL ARTICLE:

http://www.jbmr-online.com/fulltext/02003/04640/JBMR0200304640.html

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