Calcium and vitamin D-3 supplementation prevents bone loss in the spine secondary to low-dose corticosteroids in patients with rheumatoid arthritis - A randomized, double-blind, placebo-controlled trial

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 D-3 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 D-3 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 D-3 (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 D-3 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 D-3. Calcium and vitamin D-3 did not improve bone mineral density at any site in patients who were not receiving corticosteroids. Conclusion: Calcium and vitamin D-3 prevented loss of bone mineral density in the lumbar spine and trochanter in patients with rheumatoid arthritis who were treated with low-dose corticosteroids.