Glucocorticoids decrease intestinal calcium absorption and increase urinary calcium excretion thus inducing a negative calcium balance. Calcium supplementation may thus attenuate bone loss in such patients. Patients should have a total daily calcium intake of 1200mg/day and vitamin D 800iU/day through diet or supplements.
In a meta-analysis (consisting of 5 trials) by Homik et al. which compared calcium and vitamin D (cholecalciferol or an active vitamin D metabolite) to calcium alone or placebo in patients using glucocorticoids there was seen to be a significant improvement in lumbar spine and radial BMD in the calcium and vitamin D group (weighted mean difference between treatment and control groups 2.6 and 2.5 percent, respectively. The results were not however statistically significant (OR 0.6, 95% CI 0.1-2.4). In one of the larger studies (n=96) patients receiving low-dose glucocorticoid therapy (mean prednisone dose of 5.6mg daily) were randomly assigned to receive calcium and vitamin D or placebo. The difference in annual rate of change in BMD was 2.65 percent (95% CI 0.73-4.57) and 2.08 percent (95% CI 0.43-3.73), for the spine and trochanter, respectively favouring calcium and vitamin D supplementation.
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