Vitamin D, calcium OK for Crohn’s-related bone loss

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Adding etidronate to calcium and vitamin D therapy is not necessary in the treatment of bone loss in patients with Crohn’s Disease, results of a new study indicate. “The addition of the bone-building drug etidronate adds no additional advantage,” Dr. Richard N. Fedorak told AMN Health.

“This is an important finding,” he noted, “since the bone-building drugs can have additional side effects including diarrhea and stomach upset that could make a Crohn’s patient feel worse.”

Etidronate, sold under the trade name Didronel (Procter & Gamble Pharmaceuticals), is one of the bisphosphonate drugs, used to treat osteoporosis.

Fedorak, at the University of Alberta in Edmonton, Canada, and colleagues, studied the effects of 2 years of calcium plus vitamin D supplementation, with or without etidronate therapy, in 154 Crohn’s disease patients with low bone mineral density.

The subjects were randomly assigned to oral etidronate (400 mg) or no treatment for 14 days. Both groups then received calcium (500 mg) and vitamin D (400 IU) for the next 76 days. This cycle was repeated every 3 months for 2 years.

Bone mineral density in the lower spine, forearm and upper thighbone—but not the total hip—increased steadily, significantly, and similarly in both treatment groups, the investigators report in the journal Clinical Gastroenterology and Hepatology.

A large number of patients with Crohn’s disease have low bone density due to treatment with steroids, poor nutrition, active inflammation, and calcium and vitamin D deficiencies, Fedorak told Reuters Health.

For Crohn’s patients with low bone density, “our trial demonstrates that treatment with calcium and vitamin D supplementation alone will increase bone density by about 4 percent per year,” he said. Adding etidronate does not appear to enhance the effects of calcium and vitamin D.

In an editorial, Dr. Charles Bernstein from the University of Manitoba in Winnipeg says this study provides reassurance that bisphosphonates are “rarely needed in inflammatory bowel disease patients” most of whom have low bone mineral density scores and many of whom are using steroids.

SOURCE: Clinical Gastroenterology and Hepatology, February 2005.

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