Effect of oral 1,25-dihydroxyvitamin D and calcium on glucocorticoid-induced osteopenia in patients with rheumatic diseases

Arthritis Rheum. 1984 Dec;27(12):1336-43. doi: 10.1002/art.1780271203.


Twenty-three rheumatic disease patients with glucocorticoid-induced osteopenia (defined by measurement of forearm bone mass) completed an 18-month double-blind, randomized study to assess the effect of oral calcium and 1,25-dihydroxyvitamin D (1,25-OH2D) or calcium and placebo on bone and mineral metabolism. Intestinal 47Ca absorption was increased (P less than 0.05) and serum parathyroid hormone levels were suppressed (P less than 0.01) by 1,25-OH2D (mean dose 0.4 micrograms/day); however, no significant gain in forearm bone mass occurred, and bone fractures were frequent in both groups. In the 1,25-OH2D group, histomorphometric analysis of iliac crest biopsy specimens demonstrated a decrease in osteoclasts/mm2 of trabecular bone (P less than 0.05) and parameters of osteoblastic activity (P less than 0.05), indicating that 1,25-OH2D reduced both bone resorption and formation. We conclude that 1,25-OH2D should not be used for treatment of glucocorticoid-induced osteopenia. Since patients receiving calcium and placebo did not exhibit a loss of forearm bone mass, elemental calcium supplementation of 500 mg daily might be useful to maintain skeletal mass in patients receiving long-term glucocorticord therapy.

MeSH terms

  • Administration, Oral
  • Bone Diseases / complications
  • Bone Diseases / drug therapy*
  • Bone Resorption / chemically induced
  • Bone Resorption / drug therapy*
  • Calcium / administration & dosage
  • Calcium / therapeutic use*
  • Dihydroxycholecalciferols / administration & dosage
  • Dihydroxycholecalciferols / therapeutic use*
  • Double-Blind Method
  • Glucocorticoids / adverse effects
  • Humans
  • Parathyroid Hormone / blood
  • Random Allocation
  • Rheumatic Diseases / complications*


  • Dihydroxycholecalciferols
  • Glucocorticoids
  • Parathyroid Hormone
  • Calcium