Glucocorticoid-induced osteoporosis in the lumbar spine, forearm, and mandible of nephrotic patients: A double-blind study on the high-dose, long-term effects of prednisone versus deflazacort
The long-term effects of high dose steroid treatment with either prednisone (PDN) or deflazacort (DFZ) were examined on various parts of the skeleton in 29 patients with nephrotic syndrome. All had normal skeleton at the start of the steroid treatment. At the beginning, PDN was given as 80 mg/day and tapered down to 20 mg/day for 1 year and DFZ was given in an equipotent dosage. Twenty-three patients completed 6 months of treatment, and 18 patients completed 12 months of treatment. Beside laboratory parameters to ensure the effect of treatment on the nephrotic syndrome, all had measurements of the bone mineral content (BMC) at 0, 6, and 12 months of treatment. BMC was measured by single photon absorptiometry of both forearms and by dual photon absorptiometry of the mandible, forearms, and lumbar spine. The effect of DFZ was compared to that of PDN due to a potential “calcium sparing” effect of DFZ. The therapeutical effects on the nephrotic syndrome were not different between the two drugs. Urinary 24-hour protein decreased from 9.9 to 1.1 g in the DFZ-treated patients and from 8.0 to 1.4 g in the PDN-treated patients. Plasma albumin concentration normalized in both groups. Both groups of steroid-treated patients had a significant reduction of the BMC levels in all parts of the skeleton. However, the bone decay rates per month were significantly different between different bone regions and between different drug regimes. In the forearm, the bone decay rate was 5.3%/year in the PDN group and 2.0%/year in the DFZ group (P<0.001). In the mandible, decay rate was 7.0%/year in both groups, and in the lumbar spine it was 12.5%/year in the PDN group and 6.8%/year in the DFZ group (P<0.01). Thus, the bone loss in the PDN-treated group was significantly higher than that of the DFZ-treated patients, despite a similar therapeutical effect on the nephrotic syndrome. Therefore, the detrimental effect of long-term steroid treatment on the skeleton may not be abolished, but can be reduced significantly by using deflazacort instead of prednisone.