糖質コルチコイド誘発骨粗鬆症に対する活性型ビタミンDおよびサイアザイド長期併用投与の有用性に関する研究

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概要

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• Thirty-eight patients with collagen diseases undergoing chronic glucocorticoid treatment were studied to assess the effect of a 24 month administration of oral 1α-hydroxyvitamin D (1α-OHD), calcium and thiazide on bone and mineral metabolism.<BR>All patients were premenopausal women (mean age = 35 y.o.) and had been treated with prednisolone (mean dose = 11mg/day). Patients were randomly divided into three groups. Fourteen patients were treated with 0.75μg of 1α-OHD and 400mg of calcium daily (1α-OHD group). Eleven patients were treated with 1α-OHD, calcium and 4mg of trichlormethiazide (thiazide group). Thirteen patients did not have any treatment for osteoporosis and served as a patient control group.<BR>There were no significant differences in age, underlying disease, dose of glucocorticoid, or pretreatment values of indices of osteoporosis among the three groups. Twenty-four hour urinary calcium excretion had increased above 300mg/g creatinine at 12 or 24 months after the start of the treatment in 9 patients of the 1α-OHD group, and asymptomatic renal stones developed in 2 of them. However, neither hypercalciuria nor renal stones developed in the thiazide group or the control group. Serum iPTH levels were suppressed significantly in the thiazide group, but did not change in the 1α-OHD group or the control group.<BR>Metacarpal index (MCI) and EGS/D, indices of microdensitometry method which indicate bone mineral content, had significantly increased after 12 and 24 months in the thiazide group, while these indices did not change significantly in the 1α-OHD group and deteriorated in the control group at 24 months. Seven patients of the control group and 4 of the 1α-OHD group showed deteriorations in Singh's grade compared to only 2 in the thiazide group.<BR>Vertebral bone fractures developed in 5 vertebras of the 2 patients in the control group and 4 of the 3 patients in the 1α-OHD group during the 24 months. But none of the thiazide group suffered from bone fractures.<BR>It may be concluded that combination therapy with 1α-OHD, calcium and thiazide is effective in the prevention of glucocorticoid-induced osteoporosis. Long-term administration of 1α-OHD and calcium should be avoided in patients undergoing chronic glucocorticoid therapy because of the risk of the development of nephrolithiasis.

• 一般社団法人 日本内分泌学会の論文

著者

• 山田 秀裕

  慶応義塾大学 医学部 内科

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• 糖質コルチコイド誘発骨粗鬆症に対する活性型ビタミンDおよびサイアザイド長期併用投与の有用性に関する研究

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