Vitamin glucocorticoid-induced

Glucocorticoid-induced osteoporosis 5 mg once daily. For postmenopausal women not receiving estrogen, the recommended dose is 10 mg once daily. Patients also should receive adequate amounts of calcium and vitamin D. 

Clodronate 100 mg by intramuscular route once a week was effective in the prevention of glucocorticoid-induced bone loss and fractures in patients with arthritis compared with calcium 1000 mg/day and vitamin D 800 mg/day... 

Other agents are effective in special populations. Vitamin K prevented bone loss in 20 patients with chronic glomerulonephritis treated with prednisolone (263) and ciclo-sporin 4.8 mg/kg/day prevented glucocorticoid-induced osteopenia in 52 patients taking prednisone 10 mg/day after kidney transplantation (264). 

Ringe JD, Dorst A, Faber H, Schacht E, Rahlfs VW. Superiority of alfacalcidol over plain vitamin D in the treatment of glucocorticoid-induced osteoporosis. Rheumatol Int 2004 24 63-70. 

Schwartzman MS, Franck WA. Vitamin D toxicity complicating the treatment of senile, postmenopausal, and glucocorticoid-induced osteoporosis. Four case reports and a critical commentary on the use of vitamin D in these disorders. Am J Med 1987 82(2) 224-30. 

Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis 2001 update. American College of Rheumatology Ad Hoc Committee on Glucocorticoid-Induced Osteoporosis. Arthritis Rheum 2001 44 1496-1503. Sharma OP. Vitamin D, calcium, and sarcoidosis. Chest 19% 109 535-539. Baughman RP, Teirstein AS, Judson MA, et aL Clinical characteristics of patients in a case control study of sarcoidosis. Am J Respir Crit Care Med 2001 164 1885-1889. Rizzato G. Clinical impact of bone and calcium metaboUsm changes in sarcoidosis. Thorax 1998 53 425 29. 

Again, this does not seem to be due to correction of vitamin Bg deficiency, but rather to a direct effect of pyridoxal phosphate on the metabolism of tryptophan. High concentrations of pyridoxal phosphate attenuate the response to glucocorticoid hormones tryptophan dioxygenase is a glucocorticoid-induced enzyme, and thus its synthesis and activity will be reduced by high intakes of vitamin Bg. This reduces the oxidative metabolism of tryptophan and increases the amount available for synthesis of 5-hydroxytryptamine in the brain. 

A number of inhibitors of carcinogen- and radiation-induced ceU transformation have been identified. These include protease inhibitors (antipain, leupeptin, soybean tryspin inhibitor), vitamin A analogs (retinoids), vitamin C (ascorbic add), glucocorticoids, and lymphotoxins (Kennedy, 1984). 

The administration of calcium and vitamin D3 can prevent bone loss induced by glucocorticoids, and trials have confirmed its efficacy when given for 2 years. Patients taking prednisone and placebo lost bone density in the lumbar spine at a rate of 2% per year. Those taking prednisone and calcium plus vitamin D3 gained bone mineral density at a rate of 0.72% per year. Calcium plus vitamin D3 did not improve bone mineral density in patients who were not taking prednisone (SEDA-21, 417 238). 

The administration of calcium and vitamin D3 can prevent bone loss induced by glucocorticoids, and trials have confirmed its efficacy when given for 2 years. Patients taking prednisone and placebo lost bone density in the... 

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