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| |  Zoledronic Acid Better for Bone Remodelling Than Risedronate in Glucocorticoid-Induced Osteoporosis: Presented at EULAR By Jill Stein PARIS -- June 15, 2008 -- In patients with glucocorticoid-induced osteoporosis, a single 5-mg zoledronic-acid infusion is faster and more effective in reducing bone turnover marker levels than oral risedronate, 5 mg/d for 12 months, according to a poster presentation on June 14 at EULAR 2008, the Annual Congress of the European League Against Rheumatism. Kenneth G. Saag, MD, University of Alabama, Birmingham, Alabama, and associates compared the effects of intravenous zoledronic acid and oral risedronate on bone remodelling in patients with glucocorticoid-induced osteoporosis. Glucocorticoid-induced osteoporosis is now recognised as one of the most important reasons for secondary osteoporosis, the authors said. In post-menopausal osteoporosis, substantial suppression of bone turnover is needed to optimise the risk of fracture reduction; however, it is critical that adequate bone remodelling be maintained during treatment. Two populations with glucocorticoid-induced osteoporosis were randomised to receive intravenous zoledronate as a single 5-mg infusion or oral risedronate, 5 mg/d, in a 1-year, double-blind, double-dummy study. All subjects received calcium 1,000 mg/d and vitamin D, 400 to 1,200 IU/d. The prevention subpopulation included 288 patients who had received 7.5 mg/d oral prednisone or more or an equivalent for 3 or more months at the time of randomisation. The treatment subpopulation included 545 patients who had received 7.5 mg/d or more of oral prednisone or an equivalent for more than 3 months at the time of randomisation. Changes from baseline in fasting serum levels of beta-C-terminal telopeptides of type 1 collagen and procollagen type 1 amino-terminal propeptide were measured at 9 to 11 days, and again at months 3, 6, and 12. Transiliac bone biopsies were performed in 23 patients (zoledronic acid, n = 12; oral risedronate, n = 11) at 12 months. Histomorphometric analysis of 23 biopsies showed that zoledronic acid and risedronate had comparable effects on static and dynamic indices of bone remodelling, with the exception of osteoid volume, which was significantly lower in zoledronic-treated patients (0.110 for zoledronic acid vs 1.225 in risedronate patients, P = .016). The results showed that in patients treated with either of the 2 agents, osteoid formation and mineralisation remained within the normal range, indicating that the formation of new bone was normal in these patients, the authors said in their poster presentation. Zoledronic acid had a favourable safety profile and was generally well tolerated. Dr. Saag and co-workers concluded that the superior reduction of bone turnover with zoledronic acid is associated with preservation of bone remodelling capacity. Funding for the study was provided by Novartis. [Presentation title: Effects of a Single 5 Mg Infusion of Zoledronic Acid and Oral Risedronate (5 Mg/Day) on Bone Remodeling Over One Year in Patients With Glucocorticoid-Induced Osteoporosis. Abstract SAT0347]
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