Osteopenia in young hypogonadal women with systemic lupus erythematosus receiving chronic steroid therapy: A randomized controlled trial comparing calcitriol and hormonal replacement therapy

Abstract

Objective. To evaluate the efficacy of calcitriol and hormonal replacement therapy (HRT) in the treatment of steroid-induced osteoporosis in hypogonadal women. Methods. We studied 28 young patients (aged 37 ± 6 yr) with systemic lupus erythematosus (SLE) on chronic steroid therapy for 130 ± 22 months and requiring more than 10 mg/day prednisone. They were amenorrhoeic for more than 2 yr with proven ovarian failure. All had osteopenia with a T score at L2-4 of less than -1. They were randomized to receive HRT (conjugated oestrogen 0.625 mg daily from day 1 to day 21 plus medroxyprogesterone acetate 5 mg daily days 10-21) or calcitriol 0.5 μg daily. All received calcium carbonate 1 g/day. Results. There were no differences in the baseline demographic, bone mineral density (BMD) and biochemical data between the two groups. Lumbar spine BMD increased by 2.0 ± 0.4% after 2 yr with HRT (P < 0.05), but reduced by 1.74 ± 0.4% (P < 0.05) with calcitriol treatment. No change was seen at the distal one-third radius with HRT treatment but significant bone loss (2.3 ± 1.4%, P < 0.02) was observed with calcitriol therapy. BMD at the hip did not change in both groups. Comparing both treatment groups, significant differences in the BMD at the spine (P < 0.03) and radius (P < 0.05) were seen at the end of 2 yr. The changes in urinary n-telopeptide excretion but not serum osteocalcin at 6 months and 12 months were inversely correlated with the changes in lumbar spine BMD at 24 months. HRT did not cause an adverse effect on SLE disease activity. Conclusion. HRT but not calcitriol could prevent bone loss in young hypogonadal women on chronic steroid therapy.