A team from Toronto, Ontario, Canada, investigated the effect of corticosteroids on bone mineral density (BMD) in patients with Crohn's disease.
They compared the effect of budesonide, a steroid with low systemic activity, with prednisone and nonsteroid therapy.
Prospective annual BMDs of the lumbar spine (LS) and femoral neck (FN) were measured for 2 years in 138 patients with quiescent Crohn's disease.
The patients were treated with mean daily doses of 8.5 mg of budesonide (n = 48), 10.5 mg of prednisone (n = 45), or nonsteroid drugs (n = 45).
Between baseline and 1 year, the mean LS BMD decreased 2.4% in the budesonide group, 0.6% in the prednisone group, and 0.1% in the nonsteroid group.
The investigators found that the difference between budesonide and nonsteroid groups was significant.
In the second year, LS BMD did not change in the three groups.
| Lumbar spine and femoral neck BMD decreased in patients taking budesonide.
| American Journal of Gastroenterology |
After 2 years, FN BMD decreased 2.9% in the budesonide group, 0.4% in the prednisone group, and 1.1% in the nonsteroid group; the differences among groups were not significant.
The proportion of patients with bone loss of more than 2% per annum, at the LS and FN, was found to be higher in the budesonide group than in the nonsteroid group and prednisone group.
Dr Maria Cino, of the Mount Sinai Hospital, University of Toronto, said on behalf of her colleagues, "Patients with Crohn's disease, receiving maintenance treatment for 2 years with prednisone, show little change in BMD.
"On the other hand, treatment with budesonide may be associated with LS and FN bone loss."
"Budesonide does not confer an advantage over low-dose prednisone for the preservation of BMD," she concluded.