Ibandronate increases cortical bone density in patients with systemic lupus erythematosus on long-term glucocorticoid

In this double-blind placebo-controlled study, 40 Chinese female SLE patients taking prednisolone were randomly assigned to receive either monthly oral ibandronate (150 mg) or placebo with daily 1-hydroxycholecalciferol (Alfacalcidol; 1 μg) and calcium supplement for 12 months. Assessments of bone microarchitecture by using HR-pQCT and area bone mineral density (aBMD) of the lumbar spine and hip with dual-energy x-ray absorptiometry (DXA) were performed at baseline and 12 months.No differences in baseline characteristics were found between the two groups. After 12 months, no statistical differences were noted in any of the bone densities, microarchitectural parameters, or percentage changes of these parameters, as measured with HR-pQCT or DXA between the two groups. However, within the active group, the percentage improvement was significant in cortical bone density (P = 0.023) which was absent in the placebo group. Improvement was also seen in the aBMD of both the lumbar spine (P < 0.0001) and the hip (P < 0.005). In the placebo group, the percentage increase in trabecular separation was significant (P = 0.04), and the percentage improvement in aBMD in the spine also was significant (P = 0.049).Oral ibandronate treatment improves microarchitecture in SLE patients taking long-term glucocorticoid assessed with HR-pQCT, and this new technology may have a role in assessing bony changes in future longitudinal studies in SLE patients.ClinicalTrials.gov identifier: NCT00668330.Patients taking a glucocorticoid who have sustained vertebral and nonvertebral fractures have an increase in mortality rate and a higher risk of subsequent fractures [1-4], with a reduction in quality of life [5] during the subsequent decade [6]. In some patients, the increase in risk is evident within 3 months of starting glucocorticoids [7,8]. Patients receiving long-term glucocorticoids, such as patients with systemic lupus erythematosus (SLE), are similarly at risk of developing osteoporosis and