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Calcium and Vitamin D3 Supplementation Prevents Bone Loss in the Spine Secondary to Low-Dose Corticosteroids in Patients with Rheumatoid Arthritis: A Randomized, Double-Blind, Placebo-Controlled Trial

Lenore M. Buckley, MD, MPH; Edward S. Leib, MD; Kathryn S. Cartularo, RN; Pamela M. Vacek, PhD; and Sheldon M. Cooper, MD
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From Medical College of Virginia, Richmond, Virginia; and the University of Vermont, College of Medicine, Burlington, Vermont. Acknowledgments: The authors thank John Orav, PhD, and Bruce Hillner, MD, for their advice and comments; Mary Merchant, RN, for research assistance; and Maia Eckler for secretarial assistance. Requests for Reprints: Lenore M. Buckley, MD, MPH, Medical College of Virginia, 1200 East Broad Street, PO Box 980102, Richmond, VA 23298-0102. Current Author Addresses: Dr. Buckley: Medical College of Virginia, 1200 East Broad Street, PO Box 980102, Richmond, VA 23298-0102.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1996;125(12):961-968. doi:10.7326/0003-4819-125-12-199612150-00004
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Background: Therapy with low-dose corticosteroids is commonly used to treat allergic and autoimmune diseases. Long-term use of corticosteroids can lead to loss of bone mineral density and higher risk for vertebral fractures. Calcium and vitamin D3 supplementation is rational therapy for minimizing bone loss, but little evidence for its effectiveness exists.

Objective: To assess 1) the effects of supplemental calcium and vitamin D3 on bone mineral density of patients with rheumatoid arthritis and 2) the relation between the effects of this supplementation and corticosteroid use.

Design: 2-year randomized, double-blind, placebo-controlled trial.

Setting: University outpatient-care facility.

Patients: 96 patients with rheumatoid arthritis, 65 of whom were receiving treatment with corticosteroids (mean dosage, 5.6 mg/d).

Intervention: Calcium carbonate (1000 mg/d) and vitamin D3 (500 IU/d) or placebo.

Measurements: Bone mineral densities of the lumbar spine and femur were determined annually.

Results: Patients receiving prednisone therapy who were given placebo lost bone mineral density in the lumbar spine and trochanter at a rate of 2.0% and 0.9% per year, respectively. Patients receiving prednisone therapy who were given calcium and vitamin D3 gained bone mineral density in the lumbar spine and trochanter at a rate of 0.72% (P = 0.005) and 0.85% (P = 0.024) per year, respectively. In patients receiving prednisone therapy, bone mineral densities of the femoral neck and the Ward triangle did not increase significantly with calcium and vitamin D3. Calcium and vitamin D3 did not improve bone mineral density, at any site in patients who were not receiving corticosteroids.

Conclusion: Calcium and vitamin D3 prevented loss of bone mineral density in the lumbar spine and trochanter in patients with rheumatoid arthritis who were treated with low-dose corticosteroids.


Grahic Jump Location
Figure 1. All patients. Patients receiving prednisone. Patients not receiving prednisone. Solid lines indicate values for patients in the calcium and vitamin D group; dashed lines indicate values for patients in the placebo group. Bars represent 95% Cls. A significant difference was seen between the rate of change in bone mineral densities of the spine and trochanter over 2 years in all patients and in patients receiving prednisone.
Change in bone mineral density during the 2-year study period in patients with rheumatoid arthritis. Top.Middle.Bottom.3
Grahic Jump Location




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